MEDICARE: DR. WESLEY DALE MOORE D.C.

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	1301	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08633	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1316136823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY DALE MOORE D.C.

Provider Business Mailing Address
First Line	:	405 COOPER DR
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-2817
Country	:	US
Telephone Number	:	910-592-8848
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 COOPER DR
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-2817
Country	:	US
Telephone Number	:	910-592-8848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2007
Last Update Date	:	01/16/2008

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