Provider Demographics
NPI:1275723728
Name:HOLT MOORE, CANDICE SUZETTE STINNETT (DC)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:SUZETTE STINNETT
Last Name:HOLT MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CANDICE
Other - Middle Name:SUZETTE
Other - Last Name:STINNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:775 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5991
Mailing Address - Country:US
Mailing Address - Phone:501-504-6999
Mailing Address - Fax:501-205-8431
Practice Address - Street 1:775 AMITY RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5991
Practice Address - Country:US
Practice Address - Phone:501-504-6999
Practice Address - Fax:501-205-8431
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1714111N00000X
PAAJ010165111N00000X
PADC010363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor