Provider Demographics
NPI:1609170216
Name:MORAN, BRETT A (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
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 1:1448 S TEUT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-7251
Mailing Address - Country:US
Mailing Address - Phone:262-767-0500
Mailing Address - Fax:
Practice Address - Street 1:1448 S TEUT RD
Practice Address - Street 2:SUITE D
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-7251
Practice Address - Country:US
Practice Address - Phone:262-767-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4700-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor