Provider Demographics
NPI:1780690966
Name:MOREAU, SUSAN RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RENEE
Last Name:MOREAU
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 1:2383 LOMITA BLVD
Mailing Address - Street 2:#115
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717
Mailing Address - Country:US
Mailing Address - Phone:310-534-1900
Mailing Address - Fax:310-534-1771
Practice Address - Street 1:2383 LOMITA BLVD
Practice Address - Street 2:#115
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717
Practice Address - Country:US
Practice Address - Phone:310-534-1900
Practice Address - Fax:310-534-1771
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC25907Medicare UPIN