Provider Demographics
NPI:1841444239
Name:THERAL E. MORGAN DC PA
Entity type:Organization
Organization Name:THERAL E. MORGAN DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:THERAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:843-448-7656
Mailing Address - Street 1:3500 N KINGS HWY
Mailing Address - Street 2:PO BOX 8466
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2932
Mailing Address - Country:US
Mailing Address - Phone:843-448-7656
Mailing Address - Fax:
Practice Address - Street 1:3500 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2932
Practice Address - Country:US
Practice Address - Phone:843-448-7656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT247790281Medicare PIN