Provider Demographics
NPI:1568555605
Name:MOREAU, PHILIPPE MACHABEE (DC)
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:MACHABEE
Last Name:MOREAU
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 1:802 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-2849
Mailing Address - Country:US
Mailing Address - Phone:360-736-6263
Mailing Address - Fax:360-736-0811
Practice Address - Street 1:802 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-2849
Practice Address - Country:US
Practice Address - Phone:360-736-6263
Practice Address - Fax:360-736-0811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU30624Medicare UPIN
WA115000410Medicare ID - Type Unspecified