Provider Demographics
NPI:1588719496
Name:MORIARTY, KEVIN SEAN (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SEAN
Last Name:MORIARTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W HOLLIS ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1358
Mailing Address - Country:US
Mailing Address - Phone:603-595-7434
Mailing Address - Fax:603-595-1302
Practice Address - Street 1:505 W HOLLIS ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1358
Practice Address - Country:US
Practice Address - Phone:603-595-7434
Practice Address - Fax:603-595-1302
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH246-1086A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000442Medicaid
NH3333Medicare UPIN
NH290011Medicare UPIN
NHNA1559Medicare UPIN
NH4404095Medicare UPIN
NHNH0442Medicare ID - Type Unspecified
NH506395Medicare UPIN
NH80000442Medicaid