Healthcare Provider Details

I. General information

NPI: 1003771288
Provider Name (Legal Business Name): ZACKARY R MOORE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 W WHITE RIVER BLVD
MUNCIE IN
47303-3868
US

IV. Provider business mailing address

822 W WHITE RIVER BLVD
MUNCIE IN
47303-3868
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-4769
  • Fax: 765-284-8595
Mailing address:
  • Phone: 765-288-4769
  • Fax: 765-284-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003563A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: