Sean Moran, D.C., M.S.
Individual provider Active NPI Chiropractor · Bryan, OH
NPI 1154466860 · NPPES record last updated Nov 17, 2016
Key facts
- NPI
- 1154466860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2976 (OH)
- Practice address
- 1113 W High St
Bryan, OH 43506-1541 - Phone
- (419) 636-5279
- Fax
- (419) 636-5805
- NPI assigned
- Feb 20, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190610001726 | AZ | Practitioner - Chiropractic | 4082656319 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2976 | OH | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Chiropractic Injury Clinic, LLC | Chiropractor | Current | Accepting new patients |
| Bennett Clinic LLC | Current |
Accepting new patients | |
| Bennett Clinic LLC | Current |
Accepting new patients |
Locations
3191 Stillwater Dr
Ste B
Prescott, AZ 86305
Phone (928) 212-1479
1202 Willow Creek Rd
Prescott, AZ 86301
Phone (928) 771-9400
7749 E Florentine Rd
Ste B
Prescott Vly, AZ 86314
Phone (928) 308-7161
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2976 | OH | Yes |
Addresses
Primary practice location
1113 W High St
Bryan, OH 43506-1541
Mailing address
1113 W High St
Bryan, OH 43506-1541
Phone (419) 636-5279
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2263705 | Medicaid | OH |
Other providers in Bryan, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.