Provider Demographics
NPI:1225059876
Name:MOORE, BRIAN GARY (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:GARY
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 1:212 E PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3328
Mailing Address - Country:US
Mailing Address - Phone:724-838-7700
Mailing Address - Fax:724-838-7200
Practice Address - Street 1:212 E PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3328
Practice Address - Country:US
Practice Address - Phone:724-838-7700
Practice Address - Fax:724-838-7200
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005978L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019074800002Medicaid
U49187Medicare UPIN
PA764371UZWMedicare ID - Type Unspecified