Healthcare Provider Details

I. General information

NPI: 1174666846
Provider Name (Legal Business Name): MAUREEN L MOORE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MCLEAN AVE
YONKERS NY
10704-3855
US

IV. Provider business mailing address

46 SUNSET TRL SILVER BEACH GARDENS
BRONX NY
10465-3849
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-5771
  • Fax: 914-964-5773
Mailing address:
  • Phone: 718-792-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number003146
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: