Provider Demographics
NPI:1689790180
Name:MERZON, ALISSA STACEY (DC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:STACEY
Last Name:MERZON
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 1:27 ORCHARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896
Mailing Address - Country:US
Mailing Address - Phone:203-847-7999
Mailing Address - Fax:203-847-3033
Practice Address - Street 1:430 MAIN AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-847-7999
Practice Address - Fax:203-847-3033
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000888111N00000X
NJ3992111N00000X
NYX006283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000888CT01OtherBLUE CROSS BLUE SHIELD