Provider Demographics
NPI:1528102704
Name:BRANNAN, MOIRA JOANNE (DC)
Entity type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:JOANNE
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6753 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1621
Mailing Address - Country:US
Mailing Address - Phone:619-584-4847
Mailing Address - Fax:619-741-1439
Practice Address - Street 1:6753 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1621
Practice Address - Country:US
Practice Address - Phone:619-584-4847
Practice Address - Fax:619-741-1439
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111NR0400X111NR0400X
CA11NX0800X111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17023OtherCA. STATE BOARD CHIROPRACTIC EXAMINERS