Provider Demographics
NPI:1063590990
Name:MOORE, AMANDA RENEE (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RENEE
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1318 BAYTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7691
Mailing Address - Country:US
Mailing Address - Phone:214-493-2257
Mailing Address - Fax:817-424-3398
Practice Address - Street 1:6630 COLLEYVILLE BLVD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6272
Practice Address - Country:US
Practice Address - Phone:817-424-3774
Practice Address - Fax:817-424-3398
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor