Provider Demographics
NPI:1023185170
Name:MORTER, P SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:P
Middle Name:SUE
Last Name:MORTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-6500
Mailing Address - Country:US
Mailing Address - Phone:317-247-7244
Mailing Address - Fax:317-247-7255
Practice Address - Street 1:6450 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-6500
Practice Address - Country:US
Practice Address - Phone:317-247-7244
Practice Address - Fax:317-247-7255
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000092016OtherANTHEM
IN000000092016OtherANTHEM