Provider Demographics
NPI:1477658052
Name:MOREA CHIROPRACTIC WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:MOREA CHIROPRACTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-865-7474
Mailing Address - Street 1:388 N 3RD AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-9785
Mailing Address - Country:US
Mailing Address - Phone:231-865-7474
Mailing Address - Fax:231-865-7484
Practice Address - Street 1:388 N 3RD AVE
Practice Address - Street 2:SUITE L
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-9785
Practice Address - Country:US
Practice Address - Phone:231-865-7474
Practice Address - Fax:231-865-7484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P25730Medicare PIN