Provider Demographics
NPI:1164500096
Name:MORAN, JOSEPH EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:MORAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18651-1328
Mailing Address - Country:US
Mailing Address - Phone:570-417-7613
Mailing Address - Fax:
Practice Address - Street 1:640 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LARKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18651-1328
Practice Address - Country:US
Practice Address - Phone:570-417-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003684L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor