Provider Demographics
NPI:1508814856
Name:MOORE, GLORIA Z (DC)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:Z
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WHITEHALL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5268
Mailing Address - Country:US
Mailing Address - Phone:904-794-0909
Mailing Address - Fax:904-825-0240
Practice Address - Street 1:101 WHITEHALL DR STE 102
Practice Address - Street 2:SUITE A
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5268
Practice Address - Country:US
Practice Address - Phone:904-794-0909
Practice Address - Fax:904-825-0240
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor