Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 16759 | CA |
NPI | 1194803643 |
---|---|
Provider Name | Mr. Kenneth A Moreen |
First Address | Fountain Valley, CA 92708-2826 |
Second Address | Fountain Valley, CA 92708-2826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |