Provider Demographics
NPI:1366503567
Name:MERRITT, MICHAEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MERRITT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MONROE ST SE
Mailing Address - Street 2:P.O. BOX 366
Mailing Address - City:CASCADE
Mailing Address - State:IA
Mailing Address - Zip Code:52033-7751
Mailing Address - Country:US
Mailing Address - Phone:563-852-5060
Mailing Address - Fax:563-852-7889
Practice Address - Street 1:120 MONROE ST SE
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:IA
Practice Address - Zip Code:52033-7751
Practice Address - Country:US
Practice Address - Phone:563-852-5060
Practice Address - Fax:563-852-7889
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA51759OtherWELLMARK ID NUMBER
IA0127100Medicaid
IA0127100Medicaid