MEDICARE: SCOTT MARSHALL MOORE DC

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	CH8609	FL

General Provider Information

NPI Number	:	1780674358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT MARSHALL MOORE DC

Provider Business Mailing Address
First Line	:	1701 SHEPHERD RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-2179
Country	:	US
Telephone Number	:	863-646-5575
Fax Number	:	863-648-4465

Provider Business Practice Location Address
First Line	:	1701 SHEPHERD RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-2179
Country	:	US
Telephone Number	:	863-646-5575
Fax Number	:	863-648-4465

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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