Provider Demographics
NPI:1679630511
Name:MORELAND, DAVID J (D C)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:MORELAND
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E STATE ROUTE 72
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3987
Mailing Address - Country:US
Mailing Address - Phone:573-364-8086
Mailing Address - Fax:573-364-2244
Practice Address - Street 1:1410 E STATE ROUTE 72
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3987
Practice Address - Country:US
Practice Address - Phone:573-364-8086
Practice Address - Fax:573-364-2244
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO119192OtherBCBS
MO000032462Medicare PIN
MOU59088Medicare UPIN