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General NPI Number Information
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NPI Number | 1073706453
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Entity Type | Organization
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Legal Business Name | PROSPINE CHIROPRACTIC
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 804 S HOOD ST
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City | ALVIN
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State | TX
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Zip | 77511-3459
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Country | US
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Telephone | 713-300-1842
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Fax | 720-302-2522
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Provider Business Mailing Address
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Address Line | 804 S HOOD ST
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City | ALVIN
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State | TX
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Zip | 77511-3459
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Country | US
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Telephone | 713-300-1842
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Fax | 720-302-2522
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDALL B. MOORE
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Credential | DC
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Telephone | 720-985-5372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 5595
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License Number State | CO
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