Provider Demographics
NPI:1215297189
Name:MOORE, DANE ROYAL (DC)
Entity type:Individual
Prefix:
First Name:DANE
Middle Name:ROYAL
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7512 MORRO RD
Mailing Address - Street 2:ATASCADERO
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4404
Mailing Address - Country:US
Mailing Address - Phone:805-792-1400
Mailing Address - Fax:805-792-1485
Practice Address - Street 1:150 TEJAS PL
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9123
Practice Address - Country:US
Practice Address - Phone:805-931-2556
Practice Address - Fax:805-929-6440
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor