Provider Demographics
NPI:1689721326
Name:MORGAN, KEVIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:MORGAN
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 1:21 BENTLEY ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2901
Mailing Address - Country:US
Mailing Address - Phone:617-645-7908
Mailing Address - Fax:617-887-2810
Practice Address - Street 1:90 EVERETT AVE
Practice Address - Street 2:CHELSEA CHIROPRACTIC
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2337
Practice Address - Country:US
Practice Address - Phone:617-887-2730
Practice Address - Fax:617-887-2810
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2145111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA100774OtherHARVARD PILGRIM
MAAA96658OtherHARVARD PILGRIM
MA495876OtherTUFTS HEALTH PLAN
MAY36968OtherBCBS
MAY45668Medicare ID - Type Unspecified