Provider Demographics
NPI:1194956029
Name:MOORE, KIMBERLEE (MAC LIC AC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MAC LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FLETCHER ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2721
Mailing Address - Country:US
Mailing Address - Phone:978-256-0600
Mailing Address - Fax:
Practice Address - Street 1:9 FLETCHER ST UNIT 3
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2721
Practice Address - Country:US
Practice Address - Phone:978-256-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239584171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist