Provider Demographics
NPI:1134342207
Name:MERRILL, H. DAVID (DAVID MERRILL DC)
Entity type:Individual
Prefix:DR
First Name:H.
Middle Name:DAVID
Last Name:MERRILL
Suffix:
Gender:M
Credentials:DAVID MERRILL DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2706
Mailing Address - Country:US
Mailing Address - Phone:423-378-7878
Mailing Address - Fax:
Practice Address - Street 1:2504 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2706
Practice Address - Country:US
Practice Address - Phone:423-378-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU40274Medicare UPIN
TN3676613Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER#