MEDICARE: DR. ELIZABETH ANN MERRIMAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5285-12	WI

General Provider Information

NPI Number	:	1033631437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANN MERRIMAN DC

Provider Business Mailing Address
First Line	:	140 S 1ST ST STE 101
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-4317
Country	:	US
Telephone Number	:	414-271-1717
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 S 1ST ST STE 101
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-4317
Country	:	US
Telephone Number	:	414-271-1717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	12/19/2019

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