Provider Demographics
NPI:1407824071
Name:MOREAU, WILLIAM JOSEPH (DC, DACBSP, FACSM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:MOREAU
Suffix:
Gender:
Credentials:DC, DACBSP, FACSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 SE TECH CENTER PL STE 350
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9575
Mailing Address - Country:US
Mailing Address - Phone:360-326-2121
Mailing Address - Fax:360-326-2121
Practice Address - Street 1:1499 SE TECH CENTER PL STE 350
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9575
Practice Address - Country:US
Practice Address - Phone:360-326-2121
Practice Address - Fax:360-326-2121
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31802111N00000X
IA4822111N00000X
MN3578111N00000X
WACH61020299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0202531Medicaid
IA350035381OtherRR MEDICARE
57974OtherWELLMARK
IA3C173MOOtherMNBC
T01164Medicare UPIN
57974OtherWELLMARK