Healthcare Provider Details

I. General information

NPI: 1306114822
Provider Name (Legal Business Name): RICHARD GERALD MORRIS III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 BIORKA DRIVE 1ST FLOOR
DUTCH HARBOR AK
99692
US

IV. Provider business mailing address

PO BOX 921028
DUTCH HARBOR AK
99692-1028
US

V. Phone/Fax

Practice location:
  • Phone: 907-581-4689
  • Fax: 907-581-6956
Mailing address:
  • Phone: 907-581-4689
  • Fax: 907-581-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number51
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: