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General NPI Number Information
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NPI Number | 1144210212
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Entity Type | Individual
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Provider Name | JOHN RICHARD MOORE D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 809 WHEELER ST STE 2
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City | AMES
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State | IA
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Zip | 50010-4367
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Country | US
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Telephone | 515-233-1709
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Fax | 515-232-1917
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Provider Business Mailing Address
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Address Line | 809 WHEELER ST STE 2
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City | AMES
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State | IA
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Zip | 50010-4367
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Country | US
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Telephone | 515-233-1709
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Fax | 515-232-1917
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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 | A5288
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License Number State | IA
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