Provider Demographics
NPI:1255484036
Name:MOORE, KEVIN BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRIAN
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 1:716 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3439
Mailing Address - Country:US
Mailing Address - Phone:724-652-6780
Mailing Address - Fax:
Practice Address - Street 1:1004 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4282
Practice Address - Country:US
Practice Address - Phone:724-652-1772
Practice Address - Fax:724-652-0830
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002851L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA162843OtherUNISON
PAV0813BOtherUPMC
PA000988170-0001Medicaid
PA1648352OtherBLUE CROSS BLUE SHIELD
PA000988170-0001Medicaid
PAV0813BOtherUPMC