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General NPI Number Information
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NPI Number | 1003855198
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Entity Type | Individual
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Provider Name | MARTY JACOB MOORE D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 543 RIFFEL RD STE D WOOSTER, OHIO 44691
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City | WOOSTER
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State | OH
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Zip | 44691-7216
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Country | US
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Telephone | 330-262-6655
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Fax | 330-345-1615
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Provider Business Mailing Address
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Address Line | 543 RIFFEL RD SUITE D
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City | WOOSTER
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State | OH
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Zip | 44691-7216
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Country | US
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Telephone | 330-262-6655
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Fax | 330-345-1615
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3548
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License Number State | OH
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