Provider Demographics
NPI:1396923207
Name:MOORE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:MOORE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-799-8750
Mailing Address - Street 1:584 BRAWLEY SCHOOL ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8158
Mailing Address - Country:US
Mailing Address - Phone:704-799-8750
Mailing Address - Fax:704-799-8756
Practice Address - Street 1:584 BRAWLEY SCHOOL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8158
Practice Address - Country:US
Practice Address - Phone:704-799-8750
Practice Address - Fax:704-799-8756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2336822Medicare PIN