Provider Demographics
NPI:1710065339
Name:MORGAN, DWIGHT THERAL (DC)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:THERAL
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 1:3500 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2932
Mailing Address - Country:US
Mailing Address - Phone:843-448-7656
Mailing Address - Fax:843-448-7789
Practice Address - Street 1:3500 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2932
Practice Address - Country:US
Practice Address - Phone:843-448-7656
Practice Address - Fax:843-448-7789
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT837440281Medicare ID - Type Unspecified