Provider Demographics
NPI:1356449128
Name:MOREA, MICHAEL (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MOREA
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 1:388 NORTH THIRD AVENUE
Mailing Address - Street 2:SUITE L
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:231-865-7474
Mailing Address - Fax:231-865-7484
Practice Address - Street 1:388 NORTH THIRD AVENUE
Practice Address - Street 2:SUITE L
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:231-865-7474
Practice Address - Fax:231-865-7484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM008468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP25730001Medicare ID - Type Unspecified
MIU88931Medicare UPIN