Provider Demographics
NPI:1972680098
Name:JOE, MORGAN AUGUSTUS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:AUGUSTUS
Last Name:JOE
Suffix:JR
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 1:1100 S CARRINGTON CRES
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3806
Mailing Address - Country:US
Mailing Address - Phone:757-485-1434
Mailing Address - Fax:
Practice Address - Street 1:4740 BAXTER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-513-5421
Practice Address - Fax:757-490-3838
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0300390Medicaid
VA383801OtherANTHEM BCBS
VA0300390Medicaid