Provider Demographics
NPI:1871508648
Name:MORRIS, LUTHER DWAYNE (D C)
Entity Type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:DWAYNE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12087 HWY 180 & 152, SANTA CLARA, NM
Mailing Address - Street 2:P.O. BOX 770
Mailing Address - City:BAYARD
Mailing Address - State:NM
Mailing Address - Zip Code:88043
Mailing Address - Country:US
Mailing Address - Phone:505-537-2976
Mailing Address - Fax:505-537-2976
Practice Address - Street 1:12087 HWY 180 E.
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:NM
Practice Address - Zip Code:88026
Practice Address - Country:US
Practice Address - Phone:505-537-2976
Practice Address - Fax:505-537-2976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201007042OtherPRESBYTERIAN
NMNMOOK789OtherBLUE CROSS BLUE SHIELD
NM648616OtherUNITED HEALTHCARE
NM350018216OtherRAIL ROAD
NM0000T8736Medicaid
NM648616OtherUNITED HEALTHCARE
NMT40981Medicare UPIN