Provider Demographics
NPI:1346468980
Name:MORTON CHIROPACTIC CLINIC
Entity Type:Organization
Organization Name:MORTON CHIROPACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-429-6102
Mailing Address - Street 1:55 EAST COMMERCE ST.
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2215
Mailing Address - Country:US
Mailing Address - Phone:662-429-6102
Mailing Address - Fax:662-429-6044
Practice Address - Street 1:55 EAST COMMERCE ST.
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2215
Practice Address - Country:US
Practice Address - Phone:662-429-6102
Practice Address - Fax:662-429-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS122111N00000X
IL038004179111N00000X
MS1094111N00000X
IL038010451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0115111Medicaid
AL3260206OtherCIGNA
MS4474591OtherAETNA
AL3260206OtherCIGNA
T20796Medicare UPIN