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General NPI Number Information
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NPI Number | 1043637622
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Entity Type | Organization
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Legal Business Name | BLUE SKIES CHIROPRACTIC, PC
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 3502 SCOTTS LN A-13
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1561
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Country | US
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Telephone | 211-844-8484
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Fax | 215-933-5232
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Provider Business Mailing Address
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Address Line | 3502 SCOTTS LANE A-13
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City | PHILADELPHIA
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State | PA
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Zip | 19129
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Country | US
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Telephone | 211-844-8484
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Fax | 215-933-5232
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. RONALD T. MERRIEL JR.
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Credential | DC
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Telephone | 215-844-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC007899L
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License Number State | PA
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