Provider Demographics
NPI:1205247749
Name:MOORE CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:MOORE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-352-0211
Mailing Address - Street 1:1401 MARVIN RD NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5749
Mailing Address - Country:US
Mailing Address - Phone:360-491-5055
Mailing Address - Fax:360-491-5890
Practice Address - Street 1:221 KENYON ST NW STE 201
Practice Address - Street 2:221 KENYON ST NW STE 201
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4552
Practice Address - Country:US
Practice Address - Phone:360-352-0211
Practice Address - Fax:360-352-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60092035111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1821220369Medicaid
G8884906Medicare UPIN