Healthcare Provider Details

I. General information

NPI: 1972583615
Provider Name (Legal Business Name): GARY L. MORRIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 GRAVOIS RD
SAINT LOUIS MO
63123-4721
US

IV. Provider business mailing address

8000 GRAVOIS RD
SAINT LOUIS MO
63123-4721
US

V. Phone/Fax

Practice location:
  • Phone: 314-351-2500
  • Fax: 314-351-2877
Mailing address:
  • Phone: 314-351-2500
  • Fax: 314-351-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: