Provider Demographics
NPI:1124040944
Name:MORGAN, BRETT A (DC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:A
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 1:135 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1417
Mailing Address - Country:US
Mailing Address - Phone:304-768-6106
Mailing Address - Fax:304-768-6491
Practice Address - Street 1:135 7TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1417
Practice Address - Country:US
Practice Address - Phone:304-768-6106
Practice Address - Fax:304-768-6491
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7600043000Medicaid
WV001712789OtherBLUE CROSS BLUE SHIELD
U77098Medicare UPIN
WV7600043000Medicaid