1902358799 NPI number — MERRYMAN SPINAL AND SPORTS LLC

Table of content: BRANDON LAWRENCE ADLER MD (NPI 1992199251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902358799 NPI number — MERRYMAN SPINAL AND SPORTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERRYMAN SPINAL AND SPORTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902358799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2008 WAGONHAMMER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILLETTE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82718-5327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-756-2991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W LAKEWAY RD
Provider Second Line Business Practice Location Address:
SUITE. 211
Provider Business Practice Location Address City Name:
GILLETTE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82718-6361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-756-2991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MERRYMAN
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
STEFFEN
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
307-299-2941

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  763 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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