Provider Demographics
NPI:1275084253
Name:MORAN, MICHAEL (LAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 OPELOUSAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-4343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:627 OPELOUSAS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-4343
Practice Address - Country:US
Practice Address - Phone:312-880-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2019-09-02
Deactivation Date:2019-01-03
Deactivation Code:
Reactivation Date:2019-01-11
Provider Licenses
StateLicense IDTaxonomies
IL198001421171100000X
IL227015336173C00000X
LA320569171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No173C00000XOther Service ProvidersReflexologist