Provider Demographics
NPI:1588070353
Name:KEVIN S. MORIARTY, D.C. - CHIROPRACTIC OFFICE
Entity type:Organization
Organization Name:KEVIN S. MORIARTY, D.C. - CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-595-7434
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH246-1086A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000442Medicaid
NH290011Medicare UPIN
NHNA1559Medicare UPIN
NH80000442Medicaid
NH3333Medicare UPIN
NH4404095Medicare UPIN
NH506395Medicare UPIN
NH0500942Y0NH01Medicare UPIN