Healthcare Provider Details

I. General information

NPI: 1235319567
Provider Name (Legal Business Name): D. L. MOORE & ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6682 HIGHWAY 11 N SUITE 103
CARRIERE MS
39426-7554
US

IV. Provider business mailing address

PO BOX 326
PICAYUNE MS
39466-0326
US

V. Phone/Fax

Practice location:
  • Phone: 601-749-4939
  • Fax: 769-301-1641
Mailing address:
  • Phone: 601-749-4939
  • Fax: 769-301-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1118
License Number StateMS

VIII. Authorized Official

Name: DEBBIE MOORE
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 601-749-4939