Provider Demographics
NPI:1508979915
Name:MORGAN, THOMAS JACKSON JR (D C)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JACKSON
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2714
Mailing Address - Country:US
Mailing Address - Phone:757-222-9462
Mailing Address - Fax:
Practice Address - Street 1:4807 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2714
Practice Address - Country:US
Practice Address - Phone:757-498-8455
Practice Address - Fax:757-463-5764
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001216111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU-43212Medicare UPIN
VA350000938Medicare ID - Type Unspecified