Healthcare Provider Details

I. General information

NPI: 1053473009
Provider Name (Legal Business Name): SKY C MOORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 E CAMELBACK RD SUITE 430
PHOENIX AZ
85016-4325
US

IV. Provider business mailing address

2813 E CAMELBACK RD SUITE 430
PHOENIX AZ
85016-4325
US

V. Phone/Fax

Practice location:
  • Phone: 602-354-5659
  • Fax: 602-354-5896
Mailing address:
  • Phone: 602-354-5659
  • Fax: 602-354-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5531
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: