Provider Demographics
NPI:1710084090
Name:MORLOCK CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MORLOCK CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:MORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-233-4402
Mailing Address - Street 1:1602 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5152
Mailing Address - Country:US
Mailing Address - Phone:218-233-4402
Mailing Address - Fax:218-233-1026
Practice Address - Street 1:1602 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5152
Practice Address - Country:US
Practice Address - Phone:218-233-4402
Practice Address - Fax:218-233-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14599OtherNORTH DAKOTA MEDICAID
CP9044OtherRAILROAD MEDICARE
ND01394001OtherBLUE CROSS BLUE SHIELD
C07863Medicare ID - Type Unspecified