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General NPI Number Information
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NPI Number | 1962462903
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Entity Type | Individual
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Provider Name | PHILLIP MOORE D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 3609 HIGHWAY 367 N
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City | BALD KNOB
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State | AR
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Zip | 72010-9404
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Country | US
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Telephone | 501-724-2202
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Fax | 501-724-2202
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Provider Business Mailing Address
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Address Line | PO BOX 1609 3609 HWY 367 N
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City | BALD KNOB
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State | AR
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Zip | 72010-1609
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Country | US
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Telephone | 501-724-2202
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Fax | 501-724-2202
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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 | 1083
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License Number State | AR
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