Provider Demographics
NPI:1598944779
Name:MOORE ABUNDANT LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOORE ABUNDANT LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-358-0209
Mailing Address - Street 1:4008 GATEWAY DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7914
Mailing Address - Country:US
Mailing Address - Phone:817-571-9700
Mailing Address - Fax:817-358-0219
Practice Address - Street 1:4008 GATEWAY DR
Practice Address - Street 2:SUITE 180
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7914
Practice Address - Country:US
Practice Address - Phone:817-571-9700
Practice Address - Fax:817-358-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067QGOtherBCBS GROUP #
TX613000OtherMEDICARE