Provider Demographics
NPI:1528658846
Name:MOORE, MARIAH L (DC)
Entity type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:X
Other - Middle Name:X
Other - Last Name:X
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1930 E ROSEMEADE PKWY
Mailing Address - Street 2:
Mailing Address - City:CARROLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4452 ALPHA RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4505
Practice Address - Country:US
Practice Address - Phone:405-420-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor