Provider Demographics
NPI:1932345634
Name:MORAN, JOHN JAMES JR (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAMES
Last Name:MORAN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6829 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3082
Mailing Address - Country:US
Mailing Address - Phone:913-642-5857
Mailing Address - Fax:
Practice Address - Street 1:6829 W 76TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3082
Practice Address - Country:US
Practice Address - Phone:913-642-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007031078111N00000X
KS0105150111N00000X
TX08000111N00000X
AK134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor