Provider Demographics
NPI:1508343914
Name:MORGANICS, LLC
Entity Type:Organization
Organization Name:MORGANICS, LLC
Other - Org Name:PROACTIVE CHIROPRACTIC & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:LYELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-658-9995
Mailing Address - Street 1:9 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-5109
Mailing Address - Country:US
Mailing Address - Phone:209-658-9995
Mailing Address - Fax:844-892-4533
Practice Address - Street 1:213 CREEKSIDE OFFICE DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3290
Practice Address - Country:US
Practice Address - Phone:636-614-4600
Practice Address - Fax:844-892-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017018593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty