Provider Demographics
NPI:1497770796
Name:MORRISON, ROLAND VERN (RN, DC)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:VERN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:RN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11433 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-9719
Mailing Address - Country:US
Mailing Address - Phone:208-454-5147
Mailing Address - Fax:
Practice Address - Street 1:309 E LOGAN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4863
Practice Address - Country:US
Practice Address - Phone:208-455-0678
Practice Address - Fax:208-455-0679
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1672861Medicare ID - Type Unspecified