Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | OC21860 | CA |
NPI | 1003084799 |
---|---|
Provider Name | Brian S Moore |
First Address | Santa Rosa, CA 95401-3610 |
Second Address | Santa Rosa, CA 95401-3610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 14/02/2008 |