Provider Demographics
NPI:1568519239
Name:MOORE, DELORES (DAC, PHD)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 AMMONS LN
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-0299
Mailing Address - Country:US
Mailing Address - Phone:843-319-0329
Mailing Address - Fax:
Practice Address - Street 1:450 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4524
Practice Address - Country:US
Practice Address - Phone:843-319-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist