Individual provider Active NPI

Kyle Patrick Moran, DC

  • Chiropractor
  • Richmond, VA
National Provider Identifier
1902905474
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104556301 Issued in VA
Practice address
4908 Monument Avenue
100
Richmond, VA 23230-3613
Phone
(804) 254-0200
Fax
(804) 254-1953
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104556301 VA Primary

Addresses

Primary practice location

4908 Monument Avenue
100
Richmond, VA 23230-3613

Mailing address

4908 Monument Avenue
100
Richmond, VA 23230-3613
Phone (804) 254-0200

Other identifiers 1

IdentifierTypeStateIssuer
6730229OtherVAACN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140327002064 VA Practitioner - Chiropractic 4385875764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4911 Augusta Ave
Richmond, VA 23230-3601
Phone (804) 254-0200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Back in Action Chiropractic Center, P.C. CurrentSince Feb 13, 2014 Accepting new patients
Back in Action Chiropractic Center PC Chiropractor Past Accepting new patients

Locations

4911 Augusta Ave
Richmond, VA 23230
Phone (804) 254-0200

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902905474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4908 MONUMENT AVENUE",
            "address_2": "100",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232303613",
            "telephone_number": "804-254-0200",
            "fax_number": "804-254-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4908 MONUMENT AVENUE",
            "address_2": "100",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232303613",
            "telephone_number": "804-254-0200",
            "fax_number": "804-254-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORAN",
        "first_name": "KYLE",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN",
            "identifier": "6730229",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.