Healthcare Provider Details

I. General information

NPI: 1225469240
Provider Name (Legal Business Name): TIMOTHY MORIARITY LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 E. 96TH STREET SUITE 600
INDIANAPOLIS IN
46250-4453
US

IV. Provider business mailing address

6905 E. 96TH STREET SUITE 600
INDIANAPOLIS IN
46250-4453
US

V. Phone/Fax

Practice location:
  • Phone: 317-577-1990
  • Fax: 317-577-1993
Mailing address:
  • Phone: 317-577-1990
  • Fax: 317-577-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number84000125A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: