Fredrick James Moore, D.C.
Individual provider Active NPI Chiropractor · Tyrone, PA
NPI 1164536751 · NPPES record last updated Mar 14, 2016
Key facts
- NPI
- 1164536751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC002099L (PA)
- Practice address
- 5523 E Pleasant Valley Blvd
Suite #3
Tyrone, PA 16686-8570 - Phone
- (814) 684-7338
- Fax
- (814) 684-7338
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5523 E Pleasant Valley Blvd
Tyrone, PA 16686-8570
Phone (814) 684-7338
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100203000821 | PA | Practitioner - Chiropractic | 4486797123 | Practice locations: Tyrone, PA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC002099L | PA | Yes |
Addresses
Primary practice location
5523 E Pleasant Valley Blvd
Suite #3
Tyrone, PA 16686-8570
Mailing address
5523 E Pleasant Valley Blvd
Suite #3
Tyrone, PA 16686-8570
Phone (814) 684-7338
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0007527580003 | Medicaid | PA |
Other providers in Tyrone, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.