Provider Demographics
NPI:1558480699
Name:BARKDULL, MORGAN G (DC)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:G
Last Name:BARKDULL
Suffix:
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:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-0526
Mailing Address - Country:US
Mailing Address - Phone:208-354-8010
Mailing Address - Fax:208-354-3166
Practice Address - Street 1:32 WEST LITTLE AVE
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422
Practice Address - Country:US
Practice Address - Phone:208-354-8010
Practice Address - Fax:208-354-3166
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA748111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1673154Medicare ID - Type Unspecified
IDU65612Medicare UPIN