Healthcare Provider Details

I. General information

NPI: 1972680098
Provider Name (Legal Business Name): MORGAN AUGUSTUS JOE JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 BAXTER RD
VIRGINIA BEACH VA
23462
US

IV. Provider business mailing address

1100 S CARRINGTON CRES
PORTSMOUTH VA
23701-3806
US

V. Phone/Fax

Practice location:
  • Phone: 757-513-5421
  • Fax: 757-490-3838
Mailing address:
  • Phone: 757-485-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001802
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: