Provider Demographics
NPI:1093813677
Name:MORLOCK, GREGG (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:MORLOCK
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 1:1602 30TH AVE. S.
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-233-4402
Mailing Address - Fax:218-233-1026
Practice Address - Street 1:1602 30TH AVE. S.
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-233-4402
Practice Address - Fax:218-233-1026
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN875327000Medicaid
ND4353OtherBLUE CROSS BLUE SHIELD
MN875327000Medicaid
MN350003894Medicare PIN