Provider Demographics
NPI:1730110040
Name:MOORE, ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
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 1:1371 S OLD US 23
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7608
Mailing Address - Country:US
Mailing Address - Phone:810-225-7246
Mailing Address - Fax:248-432-2824
Practice Address - Street 1:1371 S OLD US 23
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7608
Practice Address - Country:US
Practice Address - Phone:810-225-7246
Practice Address - Fax:248-432-2824
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor