Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 9117 | TX |
NPI | 1750459665 |
---|---|
Provider Name | Dr. Lance D Moore |
First Address | Comfort, TX 78013-0068 |
Second Address | Comfort, TX 78013-3705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 22/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00933403 | RR MEDICARE (01) | TX |
U90350 | (02) |