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General NPI Number Information
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NPI Number | 1750567392
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Entity Type | Organization
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Legal Business Name | MERRITT CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 170 SW PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5041
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Country | US
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Telephone | 772-344-2282
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Fax | 772-344-2284
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Provider Business Mailing Address
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Address Line | 170 SW PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5041
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Country | US
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Telephone | 772-344-2282
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Fax | 772-344-2284
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT B MERRITT
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Credential | D.C
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Telephone | 772-344-2282
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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 | CH7122
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License Number State | FL
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