Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIR009103 | GA |
N | 111NN1001X | Nutrition | CHIR009103 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | CHIR009103 | GA |
Y | 111NS0005X | Chiropractic Sports Physician | CHIR009103 | GA |
NPI | 1174862122 |
---|---|
Provider Name | Dayna Moore |
First Address | Decatur, GA 30035-2017 |
Second Address | Atlanta, GA 30331-8512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2013 |
Last Update Date | 09/09/2015 |