Provider Demographics
NPI:1588779235
Name:JOHN A MORRIS DC PA
Entity type:Organization
Organization Name:JOHN A MORRIS DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-241-7907
Mailing Address - Street 1:333 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5611
Mailing Address - Country:US
Mailing Address - Phone:904-241-7907
Mailing Address - Fax:904-241-1401
Practice Address - Street 1:333 5TH AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5611
Practice Address - Country:US
Practice Address - Phone:904-241-7907
Practice Address - Fax:904-241-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34769 GROUP NUMBEROtherBCBS
FL882912Medicare ID - Type Unspecified
FL34769 GROUP NUMBEROtherBCBS