Provider Demographics
NPI:1851456511
Name:MOORE, DEANE (DC)
Entity Type:Individual
Prefix:DR
First Name:DEANE
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 1:90 ROCKLAND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2235
Mailing Address - Country:US
Mailing Address - Phone:781-826-5555
Mailing Address - Fax:781-826-1587
Practice Address - Street 1:90 ROCKLAND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2235
Practice Address - Country:US
Practice Address - Phone:781-826-5555
Practice Address - Fax:781-826-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor