Healthcare Provider Details

I. General information

NPI: 1538499157
Provider Name (Legal Business Name): COURTNEY KEESE MOORE L.AC, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CHENERY STREET SUITE C
SAN FRANCISCO CA
94131-2956
US

IV. Provider business mailing address

3664A 18TH ST
SAN FRANCISCO CA
94110-1504
US

V. Phone/Fax

Practice location:
  • Phone: 415-585-1990
  • Fax: 415-585-1990
Mailing address:
  • Phone: 541-760-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: