Provider Demographics
NPI:1942694617
Name:MJAM CHIROPRACTIC
Entity Type:Organization
Organization Name:MJAM CHIROPRACTIC
Other - Org Name:MORGAN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-569-2582
Mailing Address - Street 1:16 LUZERNE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2800
Mailing Address - Country:US
Mailing Address - Phone:570-569-2582
Mailing Address - Fax:570-569-2584
Practice Address - Street 1:16 LUZERNE AVE STE 160
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2800
Practice Address - Country:US
Practice Address - Phone:570-569-2582
Practice Address - Fax:570-569-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011003261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty