Provider Demographics
NPI:1568829299
Name:MOORE, DEREK (DC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
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 1:1600 S FEDERAL HWY
Mailing Address - Street 2:STE 451
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7525
Mailing Address - Country:US
Mailing Address - Phone:401-316-1940
Mailing Address - Fax:
Practice Address - Street 1:401 W ATLANTIC AVE UNIT 14
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444
Practice Address - Country:US
Practice Address - Phone:561-330-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor