MEDICARE: MORRIS CHIROPRACTIC CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	948	OH
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508938762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORRIS CHIROPRACTIC CLINIC, INC

Provider Business Mailing Address
First Line	:	933 ELIDA AVE
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-1785
Country	:	US
Telephone Number	:	419-692-9050
Fax Number	:	419-692-9060

Provider Business Practice Location Address
First Line	:	933 ELIDA AVE
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45891-1785
Country	:	US
Telephone Number	:	419-692-9050
Fax Number	:	419-692-9060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROGER A. MORRIS
Credential	:	D.C.
Telephone Number	:	419-692-9050

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	11/18/2011

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