Provider Demographics
NPI:1033120829
Name:MORGAN, ROBERT DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:MORGAN
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 1:565 BRUNSWICK RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-274-7007
Mailing Address - Fax:530-274-3476
Practice Address - Street 1:565 BRUNSWICK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-274-7007
Practice Address - Fax:530-274-3476
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
68 0442608Medicare ID - Type Unspecified
DCO 175300Medicare UPIN