Provider Demographics
NPI:1912972696
Name:MORGAN, KRISTY MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:MICHELLE
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:PO BOX 2954
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85062-2954
Mailing Address - Country:US
Mailing Address - Phone:602-889-5833
Mailing Address - Fax:602-889-5834
Practice Address - Street 1:12409 W INDIAN SCHOOL RD STE B210
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9505
Practice Address - Country:US
Practice Address - Phone:623-935-9920
Practice Address - Fax:623-935-9925
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009240111N00000X
AZ8050111N00000X
AZ4707111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009527700001Medicaid
PA0082072S1KOtherPROVIDER ID
PA0082072S1KOtherPROVIDER ID