Basic Information
| Provider Information | |||||||||
| NPI: | 1912972696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORGAN | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2954 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850622954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028895833 | ||||||||
| FaxNumber: | 6028895834 | ||||||||
| Practice Location | |||||||||
| Address1: | 12409 W INDIAN SCHOOL RD STE B210 | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853929505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359920 | ||||||||
| FaxNumber: | 6239359925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC009240 | PA | N | Chiropractic Providers | Chiropractor | 111N00000X | 8050 | AZ | Y | Chiropractic Providers | Chiropractor | 111NR0400X | 4707 | AZ | N | Chiropractic Providers | Chiropractor | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1009527700001 | 05 | PA | MEDICAID | 0082072S1K | 01 | PA | PROVIDER ID | OTHER |