Provider Demographics
NPI:1477935294
Name:MOORE CHIROPRACTIC
Entity Type:Organization
Organization Name:MOORE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-793-8777
Mailing Address - Street 1:2900 S TELEPHONE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2972
Mailing Address - Country:US
Mailing Address - Phone:405-793-8777
Mailing Address - Fax:405-793-1089
Practice Address - Street 1:2900 S TELEPHONE RD STE 150
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2972
Practice Address - Country:US
Practice Address - Phone:405-793-8777
Practice Address - Fax:405-793-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty