Provider Demographics
NPI:1760556005
Name:MOORE, DELROY M (DC)
Entity Type:Individual
Prefix:DR
First Name:DELROY
Middle Name:M
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 1:217 W MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1918
Mailing Address - Country:US
Mailing Address - Phone:814-938-6333
Mailing Address - Fax:814-938-7852
Practice Address - Street 1:217 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1918
Practice Address - Country:US
Practice Address - Phone:814-938-6333
Practice Address - Fax:814-938-7852
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002756-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010253630002Medicaid
PAT29405Medicare UPIN
PA0010253630002Medicaid