Healthcare Provider Details

I. General information

NPI: 1386701944
Provider Name (Legal Business Name): DEBBIE L MOORE DC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 05/15/2023
Certification Date: 05/03/2023
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: 601-748-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1878
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1437
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1437
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number000118
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC0003
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00720
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1118
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: