=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467510511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROY J MORRELL DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 07/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3480 FANNIN ST STE C
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-832-7776
-----------------------------------------------------
Fax | 409-832-7405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3480 FANNIN ST STE C
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-832-7776
-----------------------------------------------------
Fax | 409-832-7405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 7036
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------