Provider Demographics
NPI:1184700155
Name:MERRILL, DOUGLAS STEPHEN (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:STEPHEN
Last Name:MERRILL
Suffix:
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:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-0848
Mailing Address - Country:US
Mailing Address - Phone:207-985-2428
Mailing Address - Fax:
Practice Address - Street 1:2550 POST ROAD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090
Practice Address - Country:US
Practice Address - Phone:207-985-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR00483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111590000Medicaid
ME092843Medicare ID - Type Unspecified
ME111590000Medicaid