Healthcare Provider Details

I. General information

NPI: 1194806166
Provider Name (Legal Business Name): CRAIG RICHARD MORRIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E MILL ST SUITE 200
PLYMOUTH WI
53073-1807
US

IV. Provider business mailing address

515 E MILL ST SUITE 200
PLYMOUTH WI
53073-1807
US

V. Phone/Fax

Practice location:
  • Phone: 920-889-2083
  • Fax: 920-892-4251
Mailing address:
  • Phone: 920-889-2083
  • Fax: 920-892-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3532-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: