Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038.013346 | IL |
NPI | 1003465824 |
---|---|
Provider Name | Dr. Milton Theodore Morter III |
First Address | Rogers, AR 72756-4556 |
Second Address | Carbondale, IL 62901-8104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2019 |
Last Update Date | 04/09/2019 |