Provider Demographics
NPI:1265640544
Name:MORRIS CHIROPRACTIC CLINIC, CHARTERED
Entity Type:Organization
Organization Name:MORRIS CHIROPRACTIC CLINIC, CHARTERED
Other - Org Name:HEALTHSOURCE OF MORRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-589-1541
Mailing Address - Street 1:210 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1321
Practice Address - Country:US
Practice Address - Phone:320-589-1541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59841MOOtherBLUE CROSS BLUE SHIELD
MN4442564OtherMEDICA
MN684440000Medicaid
95L56HAOtherBLUE CROSS BLUE SHIELD
MN030701150OtherPRIMEWEST
MN251828700Medicaid
MN5284571OtherAETNA