=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881813996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOREAU CHIROPRACTIC & NEUROLOGY CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 03/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5017 W LOVERS LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75209-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-351-4070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 NICKI LN
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76014-3138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-351-4070
-----------------------------------------------------
Fax | 214-352-4074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL ROGER MOREAU
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 214-351-4070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8847
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------