Provider Demographics
NPI:1508938762
Name:MORRIS CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:MORRIS CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-692-9050
Mailing Address - Street 1:933 ELIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-1785
Mailing Address - Country:US
Mailing Address - Phone:419-692-9050
Mailing Address - Fax:419-692-9060
Practice Address - Street 1:933 ELIDA AVE
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45891-1785
Practice Address - Country:US
Practice Address - Phone:419-692-9050
Practice Address - Fax:419-692-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH948111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0319391Medicaid
OH0495334Medicaid
OH0495334Medicaid
OH0431021Medicare ID - Type UnspecifiedROGER A. MORRIS, D.C.