Provider Demographics
NPI:1467473041
Name:KILLE, MORRIS BLACKBURN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:BLACKBURN
Last Name:KILLE
Suffix:JR
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 1:1675 E SEMINOLE ST
Mailing Address - Street 2:SUITE H2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2435
Mailing Address - Country:US
Mailing Address - Phone:417-881-2295
Mailing Address - Fax:
Practice Address - Street 1:1675 E. SEMINOLE
Practice Address - Street 2:SUITE H2
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2414
Practice Address - Country:US
Practice Address - Phone:417-881-2295
Practice Address - Fax:417-881-4282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006014667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor