Provider Demographics
NPI:1235197831
Name:MORACK, MICHAEL MERLYN (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MERLYN
Last Name:MORACK
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 1:4014 S LYNN CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3360
Mailing Address - Country:US
Mailing Address - Phone:816-252-0800
Mailing Address - Fax:816-252-1055
Practice Address - Street 1:4014 S LYNN CT
Practice Address - Street 2:SUITE A
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3360
Practice Address - Country:US
Practice Address - Phone:816-252-0800
Practice Address - Fax:816-252-1055
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO609181OtherUNITED HEALTHCARE/ACN
MO2183128OtherAETNA
MOPOOO45774OtherRAILROAD MEDICARE
MO10853551OtherCAQH
MO25697028OtherBLUE CROSS BLUE SHIELD
MO416882OtherHEALTHLINK
MO10853551OtherCAQH
MO25697028OtherBLUE CROSS BLUE SHIELD