Provider Demographics
NPI:1073751830
Name:MOORE, ANGELA LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 S CLYDE MORRIS BLVD UNIT 7
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-2356
Mailing Address - Country:US
Mailing Address - Phone:479-466-7717
Mailing Address - Fax:
Practice Address - Street 1:3751 S CLYDE MORRIS BLVD UNIT 7
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2356
Practice Address - Country:US
Practice Address - Phone:479-466-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11081111N00000X
AR15629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor