Provider Demographics
NPI:1245338854
Name:MORGAN, CORRINE (DC)
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3707
Mailing Address - Country:US
Mailing Address - Phone:215-922-4782
Mailing Address - Fax:215-440-7539
Practice Address - Street 1:1019 CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3707
Practice Address - Country:US
Practice Address - Phone:215-922-4782
Practice Address - Fax:215-440-7539
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003397L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA533176Medicare ID - Type Unspecified