=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235319567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D. L. MOORE & ASSOCIATES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2007
-----------------------------------------------------
Last Update Date | 11/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6682 HIGHWAY 11 N SUITE 103
-----------------------------------------------------
City | CARRIERE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39426-7554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-749-4939
-----------------------------------------------------
Fax | 769-301-1641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 326
-----------------------------------------------------
City | PICAYUNE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39466-0326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-749-4939
-----------------------------------------------------
Fax | 769-301-1641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DEBBIE MOORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-749-4939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1118
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------