Provider Demographics
NPI:1639511462
Name:JACK R MORRIS CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:JACK R MORRIS CHIROPRACTIC CORP
Other - Org Name:AFFORDABLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-571-3453
Mailing Address - Street 1:3025 MCHENRY AVENUE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1456
Mailing Address - Country:US
Mailing Address - Phone:209-571-3453
Mailing Address - Fax:209-571-3481
Practice Address - Street 1:3025 MCHENRY AVENUE
Practice Address - Street 2:SUITE F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1456
Practice Address - Country:US
Practice Address - Phone:209-571-3453
Practice Address - Fax:209-571-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty