Provider Demographics
NPI:1144069204
Name:MORENO FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:MORENO FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/ OWNER/ AO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-908-0092
Mailing Address - Street 1:2211 NW MILITARY HWY STE 116
Mailing Address - Street 2:
Mailing Address - City:CASTLE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1859
Mailing Address - Country:US
Mailing Address - Phone:201-908-0092
Mailing Address - Fax:
Practice Address - Street 1:2211 NW MILITARY HWY STE 116
Practice Address - Street 2:
Practice Address - City:CASTLE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78213-1859
Practice Address - Country:US
Practice Address - Phone:201-908-0092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty