Provider Demographics
NPI:1528303880
Name:MOORE, JAMES MICHAEL (L AC,)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:MOORE
Suffix:
Gender:M
Credentials:L AC,
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:63316 US HIGHWAY 93 STE 300
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2740
Mailing Address - Country:US
Mailing Address - Phone:406-270-1386
Mailing Address - Fax:
Practice Address - Street 1:63316 US HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2739
Practice Address - Country:US
Practice Address - Phone:406-270-1386
Practice Address - Fax:406-676-0100
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist