Healthcare Provider Details

I. General information

NPI: 1750038014
Provider Name (Legal Business Name): CAITLIN MARIE MOORE RD, LRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N WACKER DR UNIT 201
CHICAGO IL
60606-1633
US

IV. Provider business mailing address

160 N WACKER DR UNIT 201
CHICAGO IL
60606-1633
US

V. Phone/Fax

Practice location:
  • Phone: 866-758-4388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1349
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: