Provider Demographics
NPI:1871512533
Name:MOREAU, MICHAEL ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROGER
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 1:219 NICKI LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3138
Mailing Address - Country:US
Mailing Address - Phone:972-342-8663
Mailing Address - Fax:
Practice Address - Street 1:5017 W LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3141
Practice Address - Country:US
Practice Address - Phone:214-351-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU91864Medicare UPIN
TX00192HMedicare ID - Type Unspecified