Provider Demographics
NPI:1104481951
Name:MOORE, TAYLOR (DC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 FREMONT AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5602
Mailing Address - Country:US
Mailing Address - Phone:217-891-7278
Mailing Address - Fax:
Practice Address - Street 1:851 FREMONT AVE STE 111
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5602
Practice Address - Country:US
Practice Address - Phone:217-891-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor