Provider Demographics
NPI:1235319567
Name:D. L. MOORE & ASSOCIATES, INC
Entity Type:Organization
Organization Name:D. L. MOORE & ASSOCIATES, INC
Other - Org Name:MOORE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-749-4939
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-0326
Mailing Address - Country:US
Mailing Address - Phone:601-749-4939
Mailing Address - Fax:769-301-1641
Practice Address - Street 1:6682 HIGHWAY 11 N
Practice Address - Street 2:SUITE 103
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-7554
Practice Address - Country:US
Practice Address - Phone:601-749-4939
Practice Address - Fax:769-301-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-03
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09385281Medicaid
6024190001Medicare NSC
MS512G700042Medicare PIN