Healthcare Provider Details

I. General information

NPI: 1164796207
Provider Name (Legal Business Name): ROBERT RAYMOND MOORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 PERRYSVILLE AVE
PITTSBURGH PA
15214-1761
US

IV. Provider business mailing address

3961 PERRYSVILLE AVE
PITTSBURGH PA
15214-1761
US

V. Phone/Fax

Practice location:
  • Phone: 724-331-0312
  • Fax:
Mailing address:
  • Phone: 724-331-0312
  • Fax: 702-438-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011694
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01456
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberB01456
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberB01456
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: