Provider Demographics
NPI:1952484826
Name:MICHELE K. MOORE, D.C.,P.C.
Entity Type:Organization
Organization Name:MICHELE K. MOORE, D.C.,P.C.
Other - Org Name:MOORE CHIROPRACTIC HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-459-5523
Mailing Address - Street 1:8301 SHOAL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7525
Mailing Address - Country:US
Mailing Address - Phone:512-459-5523
Mailing Address - Fax:512-459-5877
Practice Address - Street 1:8301 SHOAL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7525
Practice Address - Country:US
Practice Address - Phone:512-459-5523
Practice Address - Fax:512-459-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4982111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4982OtherTX STATE LICENSE
TN7425422662OtherTAX ID
TX1972521607OtherNPI NUMBER BASED ON SS
TX603967OtherBLUE CROSS/BLUE SHIELD
TN7425422662OtherTAX ID
TXTXB115332Medicare PIN
TX603967OtherBLUE CROSS/BLUE SHIELD