MEDICARE: DR. JORDAN SCOTT MERRILL D.C.

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	4329	OH
2	111N00000X	Chiropractor	DC0000002794	TN

General Provider Information

NPI Number	:	1720335466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN SCOTT MERRILL D.C.

Provider Business Mailing Address
First Line	:	2995 FORT HENRY DR
Second Line	:	SUITE 200
City	:	KINGSPORT
State	:	TN
Zip	:	37664-4068
Country	:	US
Telephone Number	:	423-765-9256
Fax Number	:	423-765-9258

Provider Business Practice Location Address
First Line	:	2995 FORT HENRY DR
Second Line	:	SUITE 200
City	:	KINGSPORT
State	:	TN
Zip	:	37664-4068
Country	:	US
Telephone Number	:	423-765-9256
Fax Number	:	423-765-9258

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

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	02/10/2015

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