Provider Demographics
NPI:1164836383
Name:MOORE, BRADY CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:CHRISTOPHER
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 1:3986 SHASTA ST
Mailing Address - Street 2:#101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6011
Mailing Address - Country:US
Mailing Address - Phone:858-449-3002
Mailing Address - Fax:
Practice Address - Street 1:910 GRAND AVE
Practice Address - Street 2:#109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4046
Practice Address - Country:US
Practice Address - Phone:858-449-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor