Organization
BACK MOUNTAIN NEURODIAGNOSTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK EVAN MORRIS (PRESIDENT)
(570) 696-4348
Entity
Organization
Contact information
Practice address
165 S MEMORIAL HWY, TRUCKSVILLE, PA 18708-1418
(570) 696-4348
Mailing address
165 S MEMORIAL HWY, TRUCKSVILLE, PA 18708-1418
(570) 696-4348
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
DC007819L
PA
111NN0400X
Neurology Chiropractor
DC009260
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BA1689016
GROUPBCBS
PA
Enumeration date
04/20/2007
Last updated
10/04/2007
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