Healthcare Provider Details

I. General information

NPI: 1982917571
Provider Name (Legal Business Name): JASON DAVID MOORE LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 COSGRAY RD
HILLIARD OH
43026-9880
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9777
  • Fax: 614-293-9677
Mailing address:
  • Phone: 614-293-9777
  • Fax: 614-293-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: