Provider Demographics
NPI:1770729550
Name:MOORE, TYNA LEE (ND, DC)
Entity type:Individual
Prefix:MRS
First Name:TYNA
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:ND, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 SW EASTRIDGE ST
Mailing Address - Street 2:STE 135
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5064
Mailing Address - Country:US
Mailing Address - Phone:503-644-4446
Mailing Address - Fax:503-644-1993
Practice Address - Street 1:10200 SW EASTRIDGE ST
Practice Address - Street 2:STE 135
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5064
Practice Address - Country:US
Practice Address - Phone:503-644-4446
Practice Address - Fax:503-644-1993
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1637175F00000X
OR3932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor