Provider Demographics
NPI:1912290677
Name:MOORE, CHRISTY (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
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 1:5620 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-8864
Mailing Address - Country:US
Mailing Address - Phone:941-220-6993
Mailing Address - Fax:941-220-6969
Practice Address - Street 1:5620 TARA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-8865
Practice Address - Country:US
Practice Address - Phone:941-220-6993
Practice Address - Fax:941-220-6969
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor