Provider Demographics
NPI:1073841979
Name:MOORE, CHRISTOPHER LEE (DC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 DEARBORN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7706
Mailing Address - Country:US
Mailing Address - Phone:406-728-5114
Mailing Address - Fax:406-728-8121
Practice Address - Street 1:1802 DEARBORN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7706
Practice Address - Country:US
Practice Address - Phone:406-728-5114
Practice Address - Fax:406-728-8121
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor