Provider Demographics
NPI:1063871655
Name:MOORE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:MOORE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:207-892-8356
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-0992
Mailing Address - Country:US
Mailing Address - Phone:207-892-8356
Mailing Address - Fax:207-892-1644
Practice Address - Street 1:936 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5652
Practice Address - Country:US
Practice Address - Phone:207-892-8356
Practice Address - Fax:207-892-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1939261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center