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General NPI Number Information
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NPI Number | 1720898794
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Entity Type | Individual
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Provider Name | JOSHUA WAYNE MOORE DAC. LAC
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Gender | Male
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 258 MARKET ST
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City | FLOWOOD
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State | MS
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Zip | 39232-3339
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Country | US
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Telephone | 601-953-0957
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 MECHANICSBURG RD
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City | BENTONIA
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State | MS
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Zip | 39040-8195
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Country | US
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Telephone | 601-953-0957
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00025
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License Number State | MS
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