Provider Demographics
NPI:1205961463
Name:MOORE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:MOORE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-383-9399
Mailing Address - Street 1:707 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2668
Mailing Address - Country:US
Mailing Address - Phone:940-383-9399
Mailing Address - Fax:940-566-8630
Practice Address - Street 1:707 SUNSET ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2668
Practice Address - Country:US
Practice Address - Phone:940-383-9399
Practice Address - Fax:940-566-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005MSOtherBCBS GROUP PIN
TX088445401Medicaid
TX175172901Medicaid
TX8S3560OtherBCBS PIN
TXU20720Medicare UPIN
TX088445401Medicaid
TX175172901Medicaid