Provider Demographics
NPI:1528836186
Name:MOORE, ERIC (LAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 MURRAY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1243
Mailing Address - Country:US
Mailing Address - Phone:502-439-8392
Mailing Address - Fax:
Practice Address - Street 1:805 E MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2917
Practice Address - Country:US
Practice Address - Phone:812-329-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC161171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty