Provider Demographics
NPI:1881813996
Name:MOREAU CHIROPRACTIC & NEUROLOGY CENTER, PC
Entity type:Organization
Organization Name:MOREAU CHIROPRACTIC & NEUROLOGY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:MOREAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-351-4070
Mailing Address - Street 1:219 NICKI LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3138
Mailing Address - Country:US
Mailing Address - Phone:214-351-4070
Mailing Address - Fax:214-352-4074
Practice Address - Street 1:5017 W LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3141
Practice Address - Country:US
Practice Address - Phone:214-351-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1871512533OtherNPI TYPE 1
TXU91864Medicare UPIN
TX00192HMedicare ID - Type Unspecified