Provider Demographics
NPI:1588309298
Name:MOORE, TAMMY DENISE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:DENISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6484 US HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:DIXONS MILLS
Mailing Address - State:AL
Mailing Address - Zip Code:36736-2824
Mailing Address - Country:US
Mailing Address - Phone:770-833-7247
Mailing Address - Fax:
Practice Address - Street 1:6484 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:DIXONS MILLS
Practice Address - State:AL
Practice Address - Zip Code:36736-2824
Practice Address - Country:US
Practice Address - Phone:770-833-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor