Provider Demographics
NPI:1801879697
Name:MOORE, DAVID RICHARD (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
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:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:CLARKDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:86324-0667
Mailing Address - Country:US
Mailing Address - Phone:928-634-2019
Mailing Address - Fax:928-639-0283
Practice Address - Street 1:915 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKDALE
Practice Address - State:AZ
Practice Address - Zip Code:86324-0667
Practice Address - Country:US
Practice Address - Phone:928-634-2019
Practice Address - Fax:928-639-0283
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor