Healthcare Provider Details

I. General information

NPI: 1376557413
Provider Name (Legal Business Name): JERRELL JOEL MEARES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 HIGHWAY 72 EAST
KILLEN AL
35645-9000
US

IV. Provider business mailing address

5750 HIGHWAY 72
KILLEN AL
35645-8242
US

V. Phone/Fax

Practice location:
  • Phone: 256-757-3307
  • Fax: 256-757-3306
Mailing address:
  • Phone: 256-757-3307
  • Fax: 256-757-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2106
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: