Healthcare Provider Details

I. General information

NPI: 1962978056
Provider Name (Legal Business Name): MOORE CHIROPRACTIC CLINIC LUMBERTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W MAIN AVE
LUMBERTON MS
39455-2527
US

IV. Provider business mailing address

PO BOX 326
PICAYUNE MS
39466-0326
US

V. Phone/Fax

Practice location:
  • Phone: 601-749-4939
  • Fax:
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 Number
License Number State

VIII. Authorized Official

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