Provider Demographics
NPI:1457346256
Name:MOFFATT, WILLIAM J (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:MOFFATT
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 1:228 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-2541
Mailing Address - Country:US
Mailing Address - Phone:724-930-6069
Mailing Address - Fax:
Practice Address - Street 1:389 MORGANTOWN ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4880
Practice Address - Country:US
Practice Address - Phone:724-434-2225
Practice Address - Fax:724-434-1454
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007751-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMO581344OtherHIGHMARK BC/BS
PAU80975Medicare UPIN
PA039242Medicare ID - Type Unspecified