Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 33852 | CA |
NPI | 1316451453 |
---|---|
Provider Name | Dr. Cru Cyler Moore |
First Address | Glendale, CA 91208-1226 |
Second Address | Glendale, CA 91208-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 28/11/2017 |