Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC009164 | PA |
NPI | 1174676431 |
---|---|
Provider Name | Brian Moreland |
First Address | Greensburg, PA 15601-8834 |
Second Address | Mt Pleasant, PA 15666-8900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1579647 | BLUE SHIELD (01) | PA |
P00159430 | TRAVELER'S MEDICARE (01) | GA |
U98090 | (02) | PA |