Provider Demographics
NPI:1952507469
Name:MOORE, DAVID QUINTON (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:QUINTON
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 1:315 N HEWITT DR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3043
Mailing Address - Country:US
Mailing Address - Phone:254-235-2364
Mailing Address - Fax:254-235-2467
Practice Address - Street 1:315 N HEWITT DR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3043
Practice Address - Country:US
Practice Address - Phone:254-235-2364
Practice Address - Fax:254-235-2467
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor