Provider Demographics
NPI:1609982347
Name:SMITH, MORGAN FREDRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:FREDRICK
Last Name:SMITH
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 1:4 CALLE MONTOYA
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-9302
Mailing Address - Country:US
Mailing Address - Phone:505-808-4739
Mailing Address - Fax:888-974-6127
Practice Address - Street 1:221 NM-165
Practice Address - Street 2:SUITE H
Practice Address - City:PLACITAS
Practice Address - State:NM
Practice Address - Zip Code:87043
Practice Address - Country:US
Practice Address - Phone:505-808-4739
Practice Address - Fax:888-974-6127
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34105111N00000X
GACHIR0078111N00000X
NMDC2264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV06281Medicare UPIN
GA35ZCJHXMedicare ID - Type Unspecified