Provider Demographics
NPI:1588784995
Name:MICHAEL W. MOORE D.C.,P.C.
Entity type:Organization
Organization Name:MICHAEL W. MOORE D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-743-4543
Mailing Address - Street 1:703 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-1557
Mailing Address - Country:US
Mailing Address - Phone:979-743-4543
Mailing Address - Fax:979-743-2454
Practice Address - Street 1:703 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1557
Practice Address - Country:US
Practice Address - Phone:979-743-4543
Practice Address - Fax:979-743-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty