Provider Demographics
NPI:1699405431
Name:MOORE CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:MOORE CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HALLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-472-1477
Mailing Address - Street 1:1709 NE 27TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2348
Mailing Address - Country:US
Mailing Address - Phone:503-472-1477
Mailing Address - Fax:503-472-1478
Practice Address - Street 1:1709 NE 27TH ST STE H
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2348
Practice Address - Country:US
Practice Address - Phone:503-472-1477
Practice Address - Fax:503-472-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500671634Medicaid