Provider Demographics
NPI:1033142575
Name:MORGAN, TRINA RENEE (DC)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:RENEE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:RENEE
Other - Last Name:BLACKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5724 B ELEVATOR RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073
Mailing Address - Country:US
Mailing Address - Phone:815-623-5460
Mailing Address - Fax:815-623-5485
Practice Address - Street 1:5724 B ELEVATOR RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073
Practice Address - Country:US
Practice Address - Phone:815-623-5460
Practice Address - Fax:815-623-5485
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0010132037OtherBCBS
203564Medicare ID - Type Unspecified
U80894Medicare UPIN