Provider Demographics
NPI:1750459665
Name:MOORE, LANCE D (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:D
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013-0068
Mailing Address - Country:US
Mailing Address - Phone:830-995-3887
Mailing Address - Fax:830-995-3393
Practice Address - Street 1:212 HWY 87
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013-3705
Practice Address - Country:US
Practice Address - Phone:830-995-3887
Practice Address - Fax:830-995-3393
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9117111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00933403OtherRR MEDICARE
TXP00933403OtherRR MEDICARE
TX502212ZG9WMedicare PIN
U90350Medicare UPIN