Provider Demographics
NPI:1457599573
Name:VICTORIA MOORE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:VICTORIA MOORE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-482-8700
Mailing Address - Street 1:1005 A ST
Mailing Address - Street 2:213
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3123
Mailing Address - Country:US
Mailing Address - Phone:415-482-8700
Mailing Address - Fax:
Practice Address - Street 1:1005 A ST
Practice Address - Street 2:213
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3123
Practice Address - Country:US
Practice Address - Phone:415-482-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-14907261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740340074Medicare NSC