Provider Demographics
NPI:1881785475
Name:MOREAU, CHAD ELDON (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ELDON
Last Name:MOREAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2383 LOMITA BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1446
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:SUITE 115
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1446
Practice Address - Country:US
Practice Address - Phone:310-534-1900
Practice Address - Fax:310-534-1771
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26106Medicare UPIN