Provider Demographics
NPI:1164536751
Name:MOORE, FREDRICK JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:JAMES
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 1:5523 E PLEASANT VALLEY BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-8570
Mailing Address - Country:US
Mailing Address - Phone:814-684-7338
Mailing Address - Fax:814-684-7338
Practice Address - Street 1:5523 E PLEASANT VALLEY BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-8570
Practice Address - Country:US
Practice Address - Phone:814-684-7338
Practice Address - Fax:814-684-7338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002099L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007527580003Medicaid
PAMO151469Medicare ID - Type Unspecified
PA0007527580003Medicaid