Provider Demographics
NPI:1609140318
Name:MORRIS, JONATHAN WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WESLEY
Last Name:MORRIS
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 1:5640 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3556
Mailing Address - Country:US
Mailing Address - Phone:763-537-8070
Mailing Address - Fax:763-537-9513
Practice Address - Street 1:5640 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3556
Practice Address - Country:US
Practice Address - Phone:763-537-8070
Practice Address - Fax:763-537-9513
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor