MEDICARE: DR. VICTORIA 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	111NN0400X	Neurology Chiropractor	14907	CA
2	111NS0005X	Sports Physician Chiropractor	14907	CA

General Provider Information

NPI Number	:	1740340074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA MOORE D.C.

Provider Business Mailing Address
First Line	:	34 TOMAHAWK DR
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-1649
Country	:	US
Telephone Number	:	415-482-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 A ST
Second Line	:	SUITE 213
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3123
Country	:	US
Telephone Number	:	415-482-8700
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	04/14/2014

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Directions to “ DR. VICTORIA MOORE D.C.” Practice Location

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