Healthcare Provider Details

I. General information

NPI: 1063471993
Provider Name (Legal Business Name): ANDREW L. MORNINGSTAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 S STATE ROUTE 159
GLEN CARBON IL
62034-3043
US

IV. Provider business mailing address

PO BOX 843
GLEN CARBON IL
62034-0843
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-8090
  • Fax: 618-288-4422
Mailing address:
  • Phone: 618-288-8090
  • Fax: 618-288-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: