Provider Demographics
NPI:1902358799
Name:MERRYMAN SPINAL AND SPORTS LLC
Entity Type:Organization
Organization Name:MERRYMAN SPINAL AND SPORTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:STEFFEN
Authorized Official - Last Name:MERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-299-2941
Mailing Address - Street 1:2008 WAGONHAMMER LN
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5327
Mailing Address - Country:US
Mailing Address - Phone:307-756-2991
Mailing Address - Fax:
Practice Address - Street 1:201 W LAKEWAY RD
Practice Address - Street 2:SUITE. 211
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6361
Practice Address - Country:US
Practice Address - Phone:307-756-2991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY763111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty