Provider Demographics
NPI:1952597866
Name:MOORE-FULCHER LLC
Entity Type:Organization
Organization Name:MOORE-FULCHER LLC
Other - Org Name:PRIME LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:KOREEN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-424-2225
Mailing Address - Street 1:2504 AVENUE K
Mailing Address - Street 2:STE 500
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5340
Mailing Address - Country:US
Mailing Address - Phone:972-424-2225
Mailing Address - Fax:972-424-7709
Practice Address - Street 1:2504 AVENUE K
Practice Address - Street 2:STE 500
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5340
Practice Address - Country:US
Practice Address - Phone:972-424-2225
Practice Address - Fax:972-424-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9953111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084QGOtherBLUE CROSS
8R9800OtherBLUE CROSS
TX0084QGOtherBLUE CROSS
8R9800OtherBLUE CROSS