Provider Demographics
NPI:1326059023
Name:MOREAU CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MOREAU CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-362-5236
Mailing Address - Street 1:1820 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334
Mailing Address - Country:US
Mailing Address - Phone:712-362-5236
Mailing Address - Fax:712-362-5668
Practice Address - Street 1:1820 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334
Practice Address - Country:US
Practice Address - Phone:712-362-5236
Practice Address - Fax:712-362-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0485565Medicaid
IA65327MOOtherMNBC
IA65327MOOtherMNBC