Provider Demographics
NPI:1811374176
Name:MOORE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:MOORE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-466-7717
Mailing Address - Street 1:3751 S CLYDE MORRIS BLVD UNIT 7
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-2356
Mailing Address - Country:US
Mailing Address - Phone:386-426-0023
Mailing Address - Fax:386-322-4667
Practice Address - Street 1:3751 S CLYDE MORRIS BLVD UNIT 7
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2356
Practice Address - Country:US
Practice Address - Phone:386-426-0023
Practice Address - Fax:386-322-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-11081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHS189ZMedicare PIN