Provider Demographics
NPI:1487744801
Name:MORAN, CHANTEL L (DC)
Entity type:Individual
Prefix:DR
First Name:CHANTEL
Middle Name:L
Last Name:MORAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHANTEL
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7211 EAST GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066
Mailing Address - Country:US
Mailing Address - Phone:315-637-0706
Mailing Address - Fax:315-637-0708
Practice Address - Street 1:7211 EAST GENESEE STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066
Practice Address - Country:US
Practice Address - Phone:315-637-0706
Practice Address - Fax:315-637-0708
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC106700WOtherWORKERS COMP
NYC106700WOtherWORKERS COMP
V00017Medicare UPIN