Healthcare Provider Details

I. General information

NPI: 1063659365
Provider Name (Legal Business Name): ANNA GOLD MOORE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 CANAL ST
BRATTLEBORO VT
05301-6616
US

IV. Provider business mailing address

387 CANAL ST
BRATTLEBORO VT
05301-6616
US

V. Phone/Fax

Practice location:
  • Phone: 802-267-4838
  • Fax: 802-281-3530
Mailing address:
  • Phone: 802-267-4838
  • Fax: 802-281-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011322
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: