Provider Demographics
NPI:1720152127
Name:MOORE, SHAWN D (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:D
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 AVENUE K
Mailing Address - Street 2:#700-772
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5342
Mailing Address - Country:US
Mailing Address - Phone:214-280-6574
Mailing Address - Fax:
Practice Address - Street 1:2520 AVENUE K
Practice Address - Street 2:#700-772
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5342
Practice Address - Country:US
Practice Address - Phone:214-280-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001326A111N00000X
TX4869111N00000X
CADC 18548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor