Provider Demographics
NPI:1083725444
Name:MOORE, ANDREW W (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8507 MCCULLOUGH AVE
Mailing Address - Street 2:STE A-1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6458
Mailing Address - Country:US
Mailing Address - Phone:210-525-9063
Mailing Address - Fax:210-308-0494
Practice Address - Street 1:8507 MCCULLOUGH AVE
Practice Address - Street 2:STE A-1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6458
Practice Address - Country:US
Practice Address - Phone:210-525-9063
Practice Address - Fax:210-308-0494
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4749DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601888Medicare PIN