Provider Demographics
NPI:1417172792
Name:FIRST MERRITT CHIROPRACTICACUPUNCTURE PA
Entity Type:Organization
Organization Name:FIRST MERRITT CHIROPRACTICACUPUNCTURE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-453-1345
Mailing Address - Street 1:80 FORTENBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3616
Mailing Address - Country:US
Mailing Address - Phone:321-453-1345
Mailing Address - Fax:321-453-3131
Practice Address - Street 1:80 FORTENBERRY RD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3616
Practice Address - Country:US
Practice Address - Phone:321-453-1345
Practice Address - Fax:321-453-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8386111NN0400X
FLCH1275111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty