Provider Demographics
NPI:1679522734
Name:MOORE, BRYON R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYON
Middle Name:R
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 1:1065 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4210
Mailing Address - Country:US
Mailing Address - Phone:407-847-4101
Mailing Address - Fax:407-847-4728
Practice Address - Street 1:1065 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4210
Practice Address - Country:US
Practice Address - Phone:407-847-4101
Practice Address - Fax:407-847-4728
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11367032OtherCAQH PROVIDER ID
FLU93992Medicare UPIN
FL11367032OtherCAQH PROVIDER ID
FLU93992Medicare UPIN