1952484826 NPI number — MICHELE K. MOORE, D.C.,P.C.

Table of content: (NPI 1952484826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952484826 NPI number — MICHELE K. MOORE, D.C.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELE K. MOORE, D.C.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOORE CHIROPRACTIC HEALTH CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952484826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8301 SHOAL CREEK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78757-7525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-459-5523
Provider Business Mailing Address Fax Number:
512-459-5877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8301 SHOAL CREEK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78757-7525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-459-5523
Provider Business Practice Location Address Fax Number:
512-459-5877
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-459-5523

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  4982 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4982 . This is a "TX STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7425422662 . This is a "TAX ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1972521607 . This is a "NPI NUMBER BASED ON SS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 603967 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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