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General NPI Number Information
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NPI Number | 1255484036
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Entity Type | Individual
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Provider Name | KEVIN BRIAN MOORE D.C..
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1004 BUTLER AVE
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City | NEW CASTLE
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State | PA
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Zip | 16101-4282
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Country | US
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Telephone | 724-652-1772
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Fax | 724-652-0830
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Provider Business Mailing Address
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Address Line | 716 CUMBERLAND AVE
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City | NEW CASTLE
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State | PA
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Zip | 16101-3439
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Country | US
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Telephone | 724-652-6780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC002851L
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License Number State | PA
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