Provider Demographics
NPI:1891219465
Name:MOORE, CHANCE ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANCE
Middle Name:ALEXANDER
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 1:1806 BAILEYS TRACE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6145
Mailing Address - Country:US
Mailing Address - Phone:479-387-0557
Mailing Address - Fax:
Practice Address - Street 1:330 MALLORY STATION RD
Practice Address - Street 2:STE G27
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2861
Practice Address - Country:US
Practice Address - Phone:479-387-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor