Provider Demographics
NPI:1467925263
Name:MOORE, ALEXANDER WYCKOFF (DC, IVCA CERT)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:WYCKOFF
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC, IVCA CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 MEADOW GREEN CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5209
Mailing Address - Country:US
Mailing Address - Phone:443-370-4845
Mailing Address - Fax:
Practice Address - Street 1:3845 MEADOW GREEN CT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-5209
Practice Address - Country:US
Practice Address - Phone:443-370-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor