Provider Demographics
NPI:1851398705
Name:RICHARD W MERRITT DC PA
Entity Type:Organization
Organization Name:RICHARD W MERRITT DC PA
Other - Org Name:CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-687-8165
Mailing Address - Street 1:1253 W MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-0602
Mailing Address - Country:US
Mailing Address - Phone:863-687-8165
Mailing Address - Fax:863-687-1807
Practice Address - Street 1:1253 W MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-0602
Practice Address - Country:US
Practice Address - Phone:863-687-8165
Practice Address - Fax:863-687-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00129Medicare ID - Type UnspecifiedGOUP PROVIDER NUMBER
FLT88898Medicare UPIN