Provider Demographics
NPI:1740871318
Name:MOORE, LASHUNDRA PATRICE (DC)
Entity type:Individual
Prefix:DR
First Name:LASHUNDRA
Middle Name:PATRICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 5TH ST S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-5729
Mailing Address - Country:US
Mailing Address - Phone:662-370-0026
Mailing Address - Fax:662-370-0025
Practice Address - Street 1:221 5TH ST S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-5729
Practice Address - Country:US
Practice Address - Phone:662-370-0026
Practice Address - Fax:662-370-0025
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor