1649628488 NPI number — KELLI REBBECCA MORRIS MA60634221

Table of content: KELLI REBBECCA MORRIS MA60634221 (NPI 1649628488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649628488 NPI number — KELLI REBBECCA MORRIS MA60634221

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
KELLI
Provider Middle Name:
REBBECCA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA60634221
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649628488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1312 VANDERCOOK WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98632-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-425-6620
Provider Business Mailing Address Fax Number:
360-425-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ADVANTAGE CHIROPRACTIC AND MASSAGE
Provider Second Line Business Practice Location Address:
1312 VANDERCOOK WAY
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98632-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-425-6620
Provider Business Practice Location Address Fax Number:
360-425-1277
Provider Enumeration Date:
06/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA60634221 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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