Provider Demographics
NPI:1396347670
Name:MOORE, DAVID RICHARD III (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:MOORE
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1130 SENOIA RD STE B4
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1641
Mailing Address - Country:US
Mailing Address - Phone:770-892-2356
Mailing Address - Fax:
Practice Address - Street 1:1130 SENOIA RD STE B4
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-1641
Practice Address - Country:US
Practice Address - Phone:770-892-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor