Provider Demographics
NPI:1700182037
Name:MOORE, SHIRLEY ANN (MS, RAC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 W WACKERLY ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6993
Mailing Address - Country:US
Mailing Address - Phone:989-496-7472
Mailing Address - Fax:989-633-9130
Practice Address - Street 1:2621 W WACKERLY ST
Practice Address - Street 2:SUITE E
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6993
Practice Address - Country:US
Practice Address - Phone:989-496-7472
Practice Address - Fax:989-633-9130
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZR1200292171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist