Healthcare Provider Details

I. General information

NPI: 1679176614
Provider Name (Legal Business Name): D. L. MOORE & ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FRONT ST
PURVIS MS
39475
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 Number
License Number State

VIII. Authorized Official

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