Provider Demographics
NPI:1376734996
Name:MERRICKS, BERNADETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:
Last Name:MERRICKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 FOREST PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2281
Mailing Address - Country:US
Mailing Address - Phone:678-919-1333
Mailing Address - Fax:045-003-3814
Practice Address - Street 1:819 FOREST PKWY STE B
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2281
Practice Address - Country:US
Practice Address - Phone:678-919-1333
Practice Address - Fax:045-003-3814
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor