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General NPI Number Information
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NPI Number | 1952597866
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Entity Type | Organization
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Legal Business Name | MOORE-FULCHER LLC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 2504 AVENUE K STE 500
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City | PLANO
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State | TX
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Zip | 75074-5340
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Country | US
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Telephone | 972-424-2225
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Fax | 972-424-7709
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Provider Business Mailing Address
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Address Line | 2504 AVENUE K STE 500
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City | PLANO
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State | TX
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Zip | 75074-5340
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Country | US
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Telephone | 972-424-2225
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Fax | 972-424-7709
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. KELLI KOREEN MOORE
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Credential |
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Telephone | 972-424-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC9953
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License Number State | TX
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