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General NPI Number Information
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NPI Number | 1447596747
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Entity Type | Organization
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Legal Business Name | MORAN DIAGNOSTIC SERVICES, LLC
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 777 JORDAN LAKE AVE
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City | LAKE ODESSA
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State | MI
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Zip | 48849-1217
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Country | US
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Telephone | 616-902-5759
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Fax | 616-773-1292
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Provider Business Mailing Address
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Address Line | PO BOX 634
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City | LAKE ODESSA
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State | MI
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Zip | 48849-0634
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Country | US
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Telephone | 616-902-5759
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Fax | 616-773-1292
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER A MORAN
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Credential | DC
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Telephone | 616-902-5759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | D5394A
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License Number State | MI
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