Healthcare Provider Details

I. General information

NPI: 1366630071
Provider Name (Legal Business Name): WILLOW MOORE DC, ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4916 NE ST JOHNS RD
VANCOUVER WA
98661-2547
US

IV. Provider business mailing address

PO BOX 560
LA CENTER WA
98629-0560
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-4811
  • Fax: 360-263-4351
Mailing address:
  • Phone: 425-314-2745
  • Fax: 360-263-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number435
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number570
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001012
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60062846
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: