Provider Demographics
NPI:1174678122
Name:MOORE, ROY A (DC)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:A
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 1:936 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5652
Mailing Address - Country:US
Mailing Address - Phone:207-892-8356
Mailing Address - Fax:207-892-1644
Practice Address - Street 1:936 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5652
Practice Address - Country:US
Practice Address - Phone:207-892-8356
Practice Address - Fax:207-892-1644
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR577111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME067890Medicare PIN