Provider Demographics
NPI:1902983984
Name:MOYHER, LUCIANN U (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCIANN
Middle Name:U
Last Name:MOYHER
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 1:565 HARDEE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-4712
Mailing Address - Country:US
Mailing Address - Phone:770-445-4600
Mailing Address - Fax:770-445-3730
Practice Address - Street 1:565 HARDEE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4712
Practice Address - Country:US
Practice Address - Phone:770-445-4600
Practice Address - Fax:770-445-3730
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCQGMedicare ID - Type Unspecified