Provider Demographics
NPI:1184303117
Name:MOORE CHIROPRACTIC AND WELLNESS
Entity type:Organization
Organization Name:MOORE CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEEGAN
Authorized Official - Middle Name:BRYCE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-207-7541
Mailing Address - Street 1:210 S DEAN A MCGEE AVE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-7810
Mailing Address - Country:US
Mailing Address - Phone:405-251-5021
Mailing Address - Fax:
Practice Address - Street 1:210 S DEAN A MCGEE AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-7810
Practice Address - Country:US
Practice Address - Phone:405-251-5021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty