Provider Demographics
NPI:1659472157
Name:MORRIS, JASON CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CHARLES
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 1:5616 E MCKELLIPS RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2763
Mailing Address - Country:US
Mailing Address - Phone:480-985-5353
Mailing Address - Fax:480-985-6884
Practice Address - Street 1:5616 E MCKELLIPS RD
Practice Address - Street 2:STE. 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2763
Practice Address - Country:US
Practice Address - Phone:480-985-5353
Practice Address - Fax:480-985-6884
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ83208OtherMEDICARE GROUP NUMBER
AZZ83210Medicare ID - Type Unspecified
U80323Medicare UPIN