Provider Demographics
NPI:1407094220
Name:DR. ANGELA MOORE FAMILY CHIROPRACTIC, P.L.C.
Entity Type:Organization
Organization Name:DR. ANGELA MOORE FAMILY CHIROPRACTIC, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-466-7717
Mailing Address - Street 1:1507 PARKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-8801
Mailing Address - Country:US
Mailing Address - Phone:479-466-7717
Mailing Address - Fax:
Practice Address - Street 1:117 S DIXIELAND ST
Practice Address - Street 2:STE B
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745
Practice Address - Country:US
Practice Address - Phone:479-466-7717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty