Provider Demographics
NPI:1982723094
Name:MERRILL, DAVID N (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:MERRILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6220 E LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:STE A
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8925
Mailing Address - Country:US
Mailing Address - Phone:253-854-0400
Mailing Address - Fax:253-854-0404
Practice Address - Street 1:24017 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4975
Practice Address - Country:US
Practice Address - Phone:253-854-0400
Practice Address - Fax:253-854-0404
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH2544111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-2048442OtherTAX ID
WA103339OtherL&I
WA91-2048442OtherTAX ID