Provider Demographics
NPI:1427074798
Name:MOORE, DANIEL LEE (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6843 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8552
Mailing Address - Country:US
Mailing Address - Phone:208-267-2506
Mailing Address - Fax:208-267-6080
Practice Address - Street 1:6843 MAIN ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8552
Practice Address - Country:US
Practice Address - Phone:208-267-2506
Practice Address - Fax:208-267-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHI-822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT18038Medicare UPIN