Provider Demographics
NPI:1811023260
Name:MEROLLA CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MEROLLA CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEROLLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-996-0209
Mailing Address - Street 1:73 ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719
Mailing Address - Country:US
Mailing Address - Phone:508-996-0209
Mailing Address - Fax:508-997-4902
Practice Address - Street 1:73 ALDEN RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719
Practice Address - Country:US
Practice Address - Phone:508-996-0209
Practice Address - Fax:508-997-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9781935Medicaid
MAY39080OtherBC GRP
RI90346OtherBC RI GRP
Y39080Medicare ID - Type UnspecifiedGRP