Provider Demographics
NPI:1467480178
Name:MERRIAM, MITCHELL (DC)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MERRIAM
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 1:297 W UWCHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3361
Mailing Address - Country:US
Mailing Address - Phone:610-873-2100
Mailing Address - Fax:610-873-2505
Practice Address - Street 1:297 W UWCHLAN AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3361
Practice Address - Country:US
Practice Address - Phone:610-873-2100
Practice Address - Fax:610-873-2505
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2575L111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3656564OtherAETNA
PA0129330000OtherKEYSTONE
PA086717OtherBLUE CROSS
PAME086717Medicare ID - Type Unspecified
PAT28357Medicare UPIN