Provider Demographics
NPI:1952467839
Name:MOORE, WALTER J JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:MOORE
Suffix:JR
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 1:50 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1626
Mailing Address - Country:US
Mailing Address - Phone:603-298-7990
Mailing Address - Fax:603-298-5338
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-1626
Practice Address - Country:US
Practice Address - Phone:603-298-7990
Practice Address - Fax:603-298-5338
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH253-1086A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH9573Medicare ID - Type Unspecified