Provider Demographics
NPI:1295763019
Name:MORAN, CHRISTOPHER A (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
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 1:3639 CASS RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9153
Mailing Address - Country:US
Mailing Address - Phone:231-943-2100
Mailing Address - Fax:231-766-6161
Practice Address - Street 1:3639 CASS RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9153
Practice Address - Country:US
Practice Address - Phone:231-943-2100
Practice Address - Fax:231-766-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006134111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE910270OtherBLUE CROSS/BLUE CARE NUMB
MIOE910270OtherBLUE CROSS/BLUE CARE NUMB