Provider Demographics
NPI:1639145501
Name:MICHAEL J MOORE DC CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL J MOORE DC CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:MOORE CHIROPRACTIC WELLNESS CENTRER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-221-4200
Mailing Address - Street 1:1825 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2252
Mailing Address - Country:US
Mailing Address - Phone:530-221-4200
Mailing Address - Fax:530-221-3146
Practice Address - Street 1:1825 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2252
Practice Address - Country:US
Practice Address - Phone:530-221-4200
Practice Address - Fax:530-221-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05380Medicare UPIN
CADC0144460Medicare ID - Type Unspecified