Provider Demographics
NPI:1376557413
Name:MEARES, JERRELL JOEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRELL
Middle Name:JOEL
Last Name:MEARES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-8242
Mailing Address - Country:US
Mailing Address - Phone:256-757-3307
Mailing Address - Fax:256-757-3306
Practice Address - Street 1:5750 HIGHWAY 72 EAST
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-9000
Practice Address - Country:US
Practice Address - Phone:256-757-3307
Practice Address - Fax:256-757-3306
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALX80955Medicare UPIN