Provider Demographics
NPI:1720898794
Name:MOORE, JOSHUA WAYNE (DAC LAC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:WAYNE
Last Name:MOORE
Suffix:
Gender:M
Credentials:DAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MECHANICSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BENTONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39040-8195
Mailing Address - Country:US
Mailing Address - Phone:601-953-0957
Mailing Address - Fax:
Practice Address - Street 1:258 MARKET ST
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3339
Practice Address - Country:US
Practice Address - Phone:601-953-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAC00025171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist