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General NPI Number Information
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NPI Number | 1366630071
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Entity Type | Individual
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Provider Name | WILLOW MOORE DC, ND
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Gender | Female
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 4916 NE ST JOHNS RD
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City | VANCOUVER
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State | WA
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Zip | 98661-2547
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Country | US
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Telephone | 360-694-4811
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Fax | 360-263-4351
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Provider Business Mailing Address
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Address Line | PO BOX 560
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City | LA CENTER
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State | WA
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Zip | 98629-0560
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Country | US
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Telephone | 425-314-2745
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Fax | 360-263-4351
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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 | 435
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 570
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT00001012
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH60062846
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License Number State | WA
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