Provider Demographics
NPI:1295066256
Name:MOORE, ROY ALAN JR (DC)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:ALAN
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:ALAN
Other - Last Name:MOORE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:936 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5652
Mailing Address - Country:US
Mailing Address - Phone:207-892-8356
Mailing Address - Fax:207-892-1644
Practice Address - Street 1:936 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5652
Practice Address - Country:US
Practice Address - Phone:207-892-8356
Practice Address - Fax:207-892-1644
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPENDING111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor