Provider Demographics
NPI:1982434361
Name:MORGAN, JAXON DEWAYNE (ATC)
Entity type:Individual
Prefix:
First Name:JAXON
Middle Name:DEWAYNE
Last Name:MORGAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 W BALLAST AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1805
Mailing Address - Country:US
Mailing Address - Phone:714-925-8197
Mailing Address - Fax:
Practice Address - Street 1:21400 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-6306
Practice Address - Country:US
Practice Address - Phone:714-962-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer