Provider Demographics
NPI:1154466860
Name:MORAN, SEAN (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1541
Mailing Address - Country:US
Mailing Address - Phone:419-636-5279
Mailing Address - Fax:419-636-5805
Practice Address - Street 1:1113 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1541
Practice Address - Country:US
Practice Address - Phone:419-636-5279
Practice Address - Fax:419-636-5805
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2263705Medicaid
OH2263705Medicaid