Healthcare Provider Details

I. General information

NPI: 1841371168
Provider Name (Legal Business Name): RONALD D. MOORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7480 OLD TROY PIKE HEIGHTS CHIROPRACTOR PHYSICIANS LLC
HUBER HEIGHTS OH
45424
US

IV. Provider business mailing address

7480 OLD TROY PIKE
HUBER HEIGHTS OH
45424
US

V. Phone/Fax

Practice location:
  • Phone: 937-235-2225
  • Fax: 937-237-9973
Mailing address:
  • Phone: 937-235-2225
  • Fax: 937-237-9973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1368
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: