Provider Demographics
NPI:1558377184
Name:MORAN, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MORAN
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 1:810 BARNEGAT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SHIP BOTTOM
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-4686
Mailing Address - Country:US
Mailing Address - Phone:609-494-3353
Mailing Address - Fax:609-494-6262
Practice Address - Street 1:810 BARNEGAT AVE STE C
Practice Address - Street 2:
Practice Address - City:SHIP BOTTOM
Practice Address - State:NJ
Practice Address - Zip Code:08008-4686
Practice Address - Country:US
Practice Address - Phone:609-494-3353
Practice Address - Fax:609-494-6262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00459800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9032509Medicaid
NJP691065OtherOXFORD
NJ0684059000OtherAMERI-HEALTH
NJ0684059000OtherAMERI-HEALTH