Provider Demographics
NPI:1457471625
Name:MERLO, DOUGLAS A (DC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:MERLO
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 1:21201 BRAXFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928
Mailing Address - Country:US
Mailing Address - Phone:239-229-4646
Mailing Address - Fax:
Practice Address - Street 1:24810 BURNT PINE DR
Practice Address - Street 2:STE 1 & 2 CHIROPRACTIC & NUTRITION CENTERS OF FL INC
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134
Practice Address - Country:US
Practice Address - Phone:239-948-3280
Practice Address - Fax:239-948-3282
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350045717OtherRAILROAD MEDICARE
350045717OtherRAILROAD MEDICARE
55732Medicare ID - Type Unspecified