Provider Demographics
NPI:1538287792
Name:MOORE, DAVID C (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 N WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3944
Mailing Address - Country:US
Mailing Address - Phone:479-273-2122
Mailing Address - Fax:479-273-9679
Practice Address - Street 1:3103 N WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3944
Practice Address - Country:US
Practice Address - Phone:479-273-2122
Practice Address - Fax:479-273-9679
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59665Medicare PIN