Provider Demographics
NPI:1538156096
Name:MERRITT, COTTON DUDLEY (DC)
Entity type:Individual
Prefix:DR
First Name:COTTON
Middle Name:DUDLEY
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 1:2005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3019
Mailing Address - Country:US
Mailing Address - Phone:806-744-3800
Mailing Address - Fax:806-744-4210
Practice Address - Street 1:2005 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3019
Practice Address - Country:US
Practice Address - Phone:806-744-3800
Practice Address - Fax:806-744-4210
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752964116OtherCIGNA
TX0199790OtherDEPT OF LABOR & INDUSTRIE
TX752964116OtherHEALTHSMART
TX186014OtherHMO BLUE
TX8F3860OtherBC/BS
TX752964116OtherCORVEL
TX752964116OtherOMNI
TX752964116OtherPHCS
TX5630614OtherAETNA
TX752964116OtherFIRST HEALTH
TX752964116OtherFIRST HEALTH
TXU47920Medicare UPIN