Provider Demographics
NPI:1770576985
Name:MERRITT, BRADFORD PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:PAUL
Last Name:MERRITT
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 1:2213 E 52ND ST
Mailing Address - Street 2:STE A
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2785
Mailing Address - Country:US
Mailing Address - Phone:563-359-7298
Mailing Address - Fax:563-359-4469
Practice Address - Street 1:2213 E 52ND ST
Practice Address - Street 2:STE A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2785
Practice Address - Country:US
Practice Address - Phone:563-359-7298
Practice Address - Fax:563-359-4469
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
IAA05657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0454397Medicaid
U35781Medicare UPIN
IAI14650Medicare ID - Type Unspecified