Provider Demographics
NPI:1134210750
Name:MOORE, CHANCE (DC)
Entity type:Individual
Prefix:DR
First Name:CHANCE
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9787 N 91ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5088
Mailing Address - Country:US
Mailing Address - Phone:480-860-8300
Mailing Address - Fax:480-860-8398
Practice Address - Street 1:9787 N 91ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5088
Practice Address - Country:US
Practice Address - Phone:480-860-8300
Practice Address - Fax:480-860-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103330Medicare ID - Type UnspecifiedMEDICARE NUMBER
AZU90202Medicare UPIN