Healthcare Provider Details

I. General information

NPI: 1215246509
Provider Name (Legal Business Name): MOORE CHIROPRACTIC CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 HIGHWAY 367 N
BALD KNOB AR
72010-9404
US

IV. Provider business mailing address

3609 HIGHWAY 367 N
BALD KNOB AR
72010-9404
US

V. Phone/Fax

Practice location:
  • Phone: 501-724-2202
  • Fax:
Mailing address:
  • Phone: 501-724-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberAR1083
License Number StateAR

VIII. Authorized Official

Name: DR. PHILLIP MOORE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 501-724-2202