Healthcare Provider Details

I. General information

NPI: 1790731917
Provider Name (Legal Business Name): JOHN RICHARD MOORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8570 COTTER ST
LEWIS CENTER OH
43035-7137
US

IV. Provider business mailing address

6723 MORNINGSIDE DR.
LEWIS CENTER OH
43035-6063
US

V. Phone/Fax

Practice location:
  • Phone: 614-781-3139
  • Fax: 614-781-7816
Mailing address:
  • Phone: 740-549-0091
  • Fax: 740-549-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2457
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: