Provider Demographics
NPI:1417178716
Name:GARY MORRIS FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:GARY MORRIS FAMILY CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-351-2500
Mailing Address - Street 1:8000 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4721
Mailing Address - Country:US
Mailing Address - Phone:314-351-2500
Mailing Address - Fax:314-351-2877
Practice Address - Street 1:8000 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-4721
Practice Address - Country:US
Practice Address - Phone:314-351-2500
Practice Address - Fax:314-351-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0625293001OtherCIGNA HEALTHCARE
MO177314OtherBLUECROSSBLUESHIELD OF M
MO217947OtherANTHEM BLUECROSS/BLUE SHIELD
MO4367198OtherAETNA
MO4400453OtherUNITEDHEALTHCARE
MOT92197Medicare UPIN
MO0625293001OtherCIGNA HEALTHCARE