Provider Demographics
NPI:1972521607
Name:MOORE, MICHELE KAY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:KAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7951 SHOAL CREEK BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7567
Mailing Address - Country:US
Mailing Address - Phone:512-459-5523
Mailing Address - Fax:512-459-5877
Practice Address - Street 1:7951 SHOAL CREEK BLVD STE 230
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7567
Practice Address - Country:US
Practice Address - Phone:512-459-5523
Practice Address - Fax:512-459-5877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4982111N00000X
TX4982111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4982OtherSTATE LICENCE
TX603967OtherBLUE CROSS BLUE SHIELD
TX742542662OtherIRS
TXC06039679Medicaid
TX603967OtherBLUE CROSS BLUE SHIELD
TXT88458Medicare UPIN
TX742542662OtherIRS