Provider Demographics
NPI:1447409248
Name:MOORE, STEVEN MICHAEL (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TECHNOLOGY DR UNIT 8
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9181
Mailing Address - Country:US
Mailing Address - Phone:802-267-4838
Mailing Address - Fax:802-281-3530
Practice Address - Street 1:20 TECHNOLOGY DR UNIT 8
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-267-4838
Practice Address - Fax:802-281-3530
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0990080082175F00000X, 175F00000X
NYX0123301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022329Medicaid