MEDICARE: BRANDON MOORE CHIROPRACTIC P.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	038-010702	IL

General Provider Information

NPI Number	:	1811042229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDON MOORE CHIROPRACTIC P.C.

Provider Business Mailing Address
First Line	:	718 S COURT ST
Second Line	:
City	:	GRAYVILLE
State	:	IL
Zip	:	62844-1579
Country	:	US
Telephone Number	:	618-375-2771
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 S COURT ST
Second Line	:
City	:	GRAYVILLE
State	:	IL
Zip	:	62844-1579
Country	:	US
Telephone Number	:	618-375-2771
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRANDON M MOORE
Credential	:	D.C.
Telephone Number	:	618-375-2771

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	09/04/2012

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