Provider Demographics
NPI:1083782205
Name:CHAMPAGNE, MORGAN KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:KAY
Last Name:CHAMPAGNE
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:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:VA
Mailing Address - Zip Code:24066-1069
Mailing Address - Country:US
Mailing Address - Phone:540-966-3003
Mailing Address - Fax:540-966-0071
Practice Address - Street 1:1342 ROANOKE RD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-2571
Practice Address - Country:US
Practice Address - Phone:540-966-3003
Practice Address - Fax:540-966-0071
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIV07756Medicare UPIN
VIV07756Medicare UPIN