Provider Demographics
NPI:1376617746
Name:DEMERITT, PAUL GERALD (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GERALD
Last Name:DEMERITT
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 1:2002 W. M-21
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-725-5210
Mailing Address - Fax:989-725-6937
Practice Address - Street 1:2002 W M 21
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9318
Practice Address - Country:US
Practice Address - Phone:989-725-5210
Practice Address - Fax:989-725-6937
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1634276Medicaid
MI1634276Medicaid
MIT33601Medicare UPIN
MI1634276Medicaid