Provider Demographics
NPI:1639359581
Name:M. MORRIS FAMILY WELLNESS CENTER, P.C.
Entity Type:Organization
Organization Name:M. MORRIS FAMILY WELLNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-357-3695
Mailing Address - Street 1:11519 E APACHE TRL
Mailing Address - Street 2:#119
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-3522
Mailing Address - Country:US
Mailing Address - Phone:480-357-3695
Mailing Address - Fax:480-357-3698
Practice Address - Street 1:11518 E APACHE TRL
Practice Address - Street 2:#119
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3551
Practice Address - Country:US
Practice Address - Phone:480-357-3695
Practice Address - Fax:480-357-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDB9432OtherMEDICARE RAILROAD
AZZ82144Medicare PIN
AZU88265Medicare UPIN