Provider Demographics
NPI:1902817570
Name:MORENO, ANA C (DC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:C
Last Name:MORENO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 US HWY 25W SOUTH
Mailing Address - Street 2:STE 5
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769
Mailing Address - Country:US
Mailing Address - Phone:606-549-0123
Mailing Address - Fax:606-549-5995
Practice Address - Street 1:841 US HWY 25W SOUTH
Practice Address - Street 2:STE 5
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769
Practice Address - Country:US
Practice Address - Phone:606-549-0123
Practice Address - Fax:606-549-5995
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002830Medicaid
KY0787201Medicare ID - Type Unspecified
KY85002830Medicaid