Provider Demographics
NPI:1295018687
Name:CORE CHIROPRACTIC & SPORTS MEDICINE
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC & SPORTS MEDICINE
Other - Org Name:CORE CHIROPRACTIC & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-254-9623
Mailing Address - Street 1:15 WILDERNESS TRL
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5301
Mailing Address - Country:US
Mailing Address - Phone:713-254-9623
Mailing Address - Fax:
Practice Address - Street 1:15 WILDERNESS TRL
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5301
Practice Address - Country:US
Practice Address - Phone:713-254-9623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLOR MOORE CHIROPRACTIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111N00000XMedicaid