Provider Demographics
NPI:1174666846
Name:MOORE, MAUREEN L (DC)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SUNSET TRL
Mailing Address - Street 2:SILVER BEACH GARDENS
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3849
Mailing Address - Country:US
Mailing Address - Phone:718-792-1164
Mailing Address - Fax:
Practice Address - Street 1:675 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3855
Practice Address - Country:US
Practice Address - Phone:914-964-5771
Practice Address - Fax:914-964-5773
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003146111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
X18121Medicare PIN
T52359Medicare UPIN