Provider Demographics
NPI:1689768467
Name:MOORE, GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
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 1:2005 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2132
Mailing Address - Country:US
Mailing Address - Phone:252-824-3003
Mailing Address - Fax:252-824-3004
Practice Address - Street 1:2005 N MAIN ST # T
Practice Address - Street 2:SUITE A
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2132
Practice Address - Country:US
Practice Address - Phone:252-824-3003
Practice Address - Fax:252-824-3004
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908658Medicaid
NC08658OtherBCBS
NC8908658Medicaid
NC2453725Medicare ID - Type Unspecified