Healthcare Provider Details

I. General information

NPI: 1932200110
Provider Name (Legal Business Name): JOHN KURT MOORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 PORTOLA RD A5
PORTOLA VALLEY CA
94028-7264
US

IV. Provider business mailing address

884 PORTOLA RD A5
PORTOLA VALLEY CA
94028-7264
US

V. Phone/Fax

Practice location:
  • Phone: 650-851-4860
  • Fax: 650-851-4974
Mailing address:
  • Phone: 650-851-4860
  • Fax: 650-851-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number19920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: