MEDICARE: DR. BRYAN EUGENE MOORE D.C.

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	4273	TX
2	111N00000X	Chiropractor	15725	AR

General Provider Information

NPI Number	:	1598828709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN EUGENE MOORE D.C.

Provider Business Mailing Address
First Line	:	412 PONCE DE LEON DR
Second Line	:	STE B
City	:	HOT SPRINGS VILLAGE
State	:	AR
Zip	:	71909-8121
Country	:	US
Telephone Number	:	501-915-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 PONCE DE LEON DR
Second Line	:	STE B
City	:	HOT SPRINGS VILLAGE
State	:	AR
Zip	:	71909-8121
Country	:	US
Telephone Number	:	501-915-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/28/2013

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