MEDICARE: DR. HARRIS MOORE DC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00216300NJ	NJ

General Provider Information

NPI Number	:	1003315037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. HARRIS MOORE DC, LLC

Provider Business Mailing Address
First Line	:	2811 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-2227
Country	:	US
Telephone Number	:	201-290-3904
Fax Number	:	201-442-0446

Provider Business Practice Location Address
First Line	:	2811 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-2227
Country	:	US
Telephone Number	:	201-290-3904
Fax Number	:	201-442-0446

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. HARRIS I MOORE
Credential	:	DC
Telephone Number	:	201-290-3904

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/05/2018

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