Provider Demographics
NPI:1245942101
Name:MORAN, JACOB PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PATRICK
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 1:16 NOOSENECK HILL RD APT A
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-1512
Mailing Address - Country:US
Mailing Address - Phone:401-397-9948
Mailing Address - Fax:
Practice Address - Street 1:16 NOOSENECK HILL RD APT A
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1512
Practice Address - Country:US
Practice Address - Phone:401-397-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor