MEDICARE: BRIAN CHADWICK MOORE

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1477160810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN CHADWICK MOORE

Provider Business Mailing Address
First Line	:	1227 BLUE SLIDE RD
Second Line	:
City	:	THOMPSON FALLS
State	:	MT
Zip	:	59873-9470
Country	:	US
Telephone Number	:	805-458-2326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1227 BLUE SLIDE RD
Second Line	:
City	:	THOMPSON FALLS
State	:	MT
Zip	:	59873-9470
Country	:	US
Telephone Number	:	805-458-2326
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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Directions to “ BRIAN CHADWICK MOORE ” Practice Location

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