Provider Demographics
NPI:1982736419
Name:MERRELL, MONICA R (DC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:R
Last Name:MERRELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N MOUNTAIN AVE
Mailing Address - Street 2:B-103
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4359
Mailing Address - Country:US
Mailing Address - Phone:909-982-7626
Mailing Address - Fax:909-982-7626
Practice Address - Street 1:600 N MOUNTAIN AVE
Practice Address - Street 2:B-103
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4359
Practice Address - Country:US
Practice Address - Phone:909-982-7626
Practice Address - Fax:909-982-7626
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor