Provider Demographics
NPI:1033412127
Name:MORASH, BRENT DARREN
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DARREN
Last Name:MORASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRENT
Other - Middle Name:D
Other - Last Name:MORASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:23200 GREAT RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9136
Mailing Address - Country:US
Mailing Address - Phone:360-303-6288
Mailing Address - Fax:
Practice Address - Street 1:106 S CODY RD
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9236
Practice Address - Country:US
Practice Address - Phone:563-289-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor