Provider Demographics
NPI:1053373308
Name:VICKI M MERRICK DC PA
Entity type:Organization
Organization Name:VICKI M MERRICK DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-952-7004
Mailing Address - Street 1:PO BOX 100246
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32910-0246
Mailing Address - Country:US
Mailing Address - Phone:321-952-7004
Mailing Address - Fax:321-952-1004
Practice Address - Street 1:2060 PALM BAY RD NE
Practice Address - Street 2:SUITE #2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2931
Practice Address - Country:US
Practice Address - Phone:321-952-7004
Practice Address - Fax:321-952-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267605OtherSTAYWELL HEALTHEASE
FL22774Medicare ID - Type Unspecified
U20656Medicare UPIN