Healthcare Provider Details

I. General information

NPI: 1124118310
Provider Name (Legal Business Name): TOM MORGAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 VILLAGE WOOD DRIVE
RUSSELLVILLE AL
35654
US

IV. Provider business mailing address

PO BOX 30
RUSSELLVILLE AL
35653-0030
US

V. Phone/Fax

Practice location:
  • Phone: 256-332-4949
  • Fax: 256-332-4943
Mailing address:
  • Phone: 256-332-4949
  • Fax: 256-332-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1669
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: