Healthcare Provider Details

I. General information

NPI: 1871508648
Provider Name (Legal Business Name): LUTHER DWAYNE MORRIS D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12087 HWY 180 E.
SANTA CLARA NM
88026
US

IV. Provider business mailing address

12087 HWY 180 & 152, SANTA CLARA, NM P.O. BOX 770
BAYARD NM
88043
US

V. Phone/Fax

Practice location:
  • Phone: 505-537-2976
  • Fax: 505-537-2976
Mailing address:
  • Phone: 505-537-2976
  • Fax: 505-537-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNM 529
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: