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General NPI Number Information
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NPI Number | 1811793755
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Entity Type | Individual
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Provider Name | JOHNATHAN DAVID MORAN DC
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Gender | Male
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1924 MT GALLANT RD
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City | ROCK HILL
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State | SC
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Zip | 29732-9434
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Country | US
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Telephone | 803-323-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 3014 GREENWOOD PARK CIR
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City | ALBEMARLE
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State | NC
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Zip | 28001-8536
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Country | US
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Telephone | 910-333-2846
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 5154
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 5154
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5154
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License Number State | SC
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