Provider Demographics
NPI:1225469240
Name:MORIARITY, TIMOTHY (LAC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MORIARITY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 E. 96TH STREET SUITE 600
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4453
Mailing Address - Country:US
Mailing Address - Phone:317-577-1990
Mailing Address - Fax:317-577-1993
Practice Address - Street 1:6905 E. 96TH STREET SUITE 600
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4453
Practice Address - Country:US
Practice Address - Phone:317-577-1990
Practice Address - Fax:317-577-1993
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000125A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist