MEDICARE: L PAIGE MOOMAW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9468	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	608352	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1023239027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L PAIGE MOOMAW

Provider Business Mailing Address
First Line	:	1970 S MAIN ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5508
Country	:	US
Telephone Number	:	817-599-0061
Fax Number	:	817-599-7067

Provider Business Practice Location Address
First Line	:	1970 S MAIN ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5508
Country	:	US
Telephone Number	:	817-599-0061
Fax Number	:	817-599-7067

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LESLIE PAIGE MOOMAW
Credential	:	D.C.
Telephone Number	:	817-599-0061

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/10/2008

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Directions to “L PAIGE MOOMAW ” Practice Location

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