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General NPI Number Information
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NPI Number | 1861510885
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Entity Type | Organization
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Legal Business Name | CORY MOORE CHIROPRACTIC INC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 418 E GRAND AVE
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-2620
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Country | US
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Telephone | 805-473-9404
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Fax |
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Provider Business Mailing Address
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Address Line | 418 E GRAND AVE
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-2620
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD MOORE
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Credential | DC
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Telephone | 805-473-9404
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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 | DC28985
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License Number State | CA
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