Provider Demographics
NPI:1376733931
Name:MOORE, MICHAEL JOEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
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 1:1825 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2252
Mailing Address - Country:US
Mailing Address - Phone:530-221-4200
Mailing Address - Fax:530-221-3146
Practice Address - Street 1:1825 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2252
Practice Address - Country:US
Practice Address - Phone:530-221-4200
Practice Address - Fax:530-221-3146
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0144460Medicare PIN
CAT05380Medicare UPIN