Provider Demographics
NPI:1144583154
Name:MOORE, TRAVIS T (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:T
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:PO BOX 700688
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0688
Mailing Address - Country:US
Mailing Address - Phone:210-318-3007
Mailing Address - Fax:210-468-0682
Practice Address - Street 1:10020 RESEARCH FOREST DR UNIT A
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-6780
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:866-313-3397
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013030111N00000X
TX12473111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12473OtherCHIROPRACTIC LICENSE