Provider Demographics
NPI:1386701944
Name:MOORE, DEBBIE L (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-0326
Mailing Address - Country:US
Mailing Address - Phone:601-749-4939
Mailing Address - Fax:601-748-3818
Practice Address - Street 1:6682 HIGHWAY 11 N
Practice Address - Street 2:SUITE 103
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-7554
Practice Address - Country:US
Practice Address - Phone:601-749-4939
Practice Address - Fax:769-301-1641
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1878111N00000X
LA1437111N00000X, 111NR0400X
MS000118111NR0400X
MSAC0003171100000X
TXAC00720171100000X
MS1118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09088559Medicaid
MS6024190001Medicare NSC
MS512I350002Medicare PIN