Provider Demographics
NPI:1760479232
Name:MERRIEL, RONALD T JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:T
Last Name:MERRIEL
Suffix:JR
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 1:205 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLLINGSWOOD HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1917
Mailing Address - Country:US
Mailing Address - Phone:856-979-3224
Mailing Address - Fax:
Practice Address - Street 1:3502 SCOTTS LN
Practice Address - Street 2:A-13
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1561
Practice Address - Country:US
Practice Address - Phone:215-844-8484
Practice Address - Fax:215-933-5232
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007899L111N00000X
NJ38MC00579500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2006425000OtherBC/BS HMO
3818143OtherAETNA HMO
N13471OtherAMERIHEALTH
7269397OtherAETNA PPO
13888OtherELDERHEALTH
U90264Medicare UPIN
PA091296Medicare ID - Type Unspecified
3818143OtherAETNA HMO