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General NPI Number Information
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NPI Number | 1811489917
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Entity Type | Individual
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Provider Name | MATTHEW JORDAN MERRITT DC
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Gender | Male
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 62 S MADISON ST
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City | CARTHAGE
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State | IL
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Zip | 62321
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Country | US
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Telephone | 217-357-5239
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Fax |
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Provider Business Mailing Address
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Address Line | 62 S MADISON ST
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City | CARTHAGE
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State | IL
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Zip | 62321-4103
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Country | US
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Telephone | 217-357-5239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2018015027
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.013313
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License Number State | IL
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