Provider Demographics
NPI:1518182575
Name:MERA, ALEXANDER THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:THOMAS
Last Name:MERA
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 1:811 S PERRYVILLE RD UNIT 117
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-4323
Mailing Address - Country:US
Mailing Address - Phone:779-423-2044
Mailing Address - Fax:779-423-2045
Practice Address - Street 1:811 S PERRYVILLE RD UNIT 117
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-4323
Practice Address - Country:US
Practice Address - Phone:779-423-2044
Practice Address - Fax:779-423-2045
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532425OtherBCBS IL
ILK37783Medicare PIN