Provider Demographics
NPI:1740506369
Name:MORRIS CHIROPRACTIC CENTER PA
Entity type:Organization
Organization Name:MORRIS CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:575-537-2976
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NM
Mailing Address - Zip Code:88023-0770
Mailing Address - Country:US
Mailing Address - Phone:575-537-2976
Mailing Address - Fax:575-537-2976
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:88026-0000
Practice Address - Country:US
Practice Address - Phone:575-537-2976
Practice Address - Fax:575-537-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM529261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000T8736Medicaid
NM000T8736Medicaid