Provider Demographics
NPI:1629115084
Name:CAVALIER CHIROPRACTIC
Entity Type:Organization
Organization Name:CAVALIER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:AUGUSTUS
Authorized Official - Last Name:JOE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:757-513-5421
Mailing Address - Street 1:1100 S CARRINGTON CRES
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3806
Mailing Address - Country:US
Mailing Address - Phone:757-513-5421
Mailing Address - Fax:
Practice Address - Street 1:4740 BAXTER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-513-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA383801OtherANTHEM BCBS
VA0300390Medicaid
VA0300390Medicaid
VA383801OtherANTHEM BCBS