Provider Demographics
NPI:1407824071
Name:MOREAU, WILLIAM JOSEPH (DC, DACBSP, FACSM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:MOREAU
Suffix:
Gender:M
Credentials:DC, DACBSP, FACSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLYMPIC PLAZA
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-866-4040
Mailing Address - Fax:719-866-2172
Practice Address - Street 1:1750 EAST BOULDER STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-866-4554
Practice Address - Fax:719-632-9282
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4822111N00000X
MN3578111N00000X
IA31802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA350035381OtherRR MEDICARE
57974OtherWELLMARK
IA3C173MOOtherMNBC
IA0202531Medicaid
T01164Medicare UPIN
57974OtherWELLMARK