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General NPI Number Information
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NPI Number | 1598005662
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Entity Type | Organization
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Legal Business Name | MOORE MOBILE CHIROPRACTIC SC
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 658 BROADVIEW AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-4833
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Country | US
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Telephone | 847-780-7331
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Fax |
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Provider Business Mailing Address
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Address Line | 658 BROADVIEW AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-4833
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Country | US
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Telephone | 847-780-7331
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | SARAH A MOORE
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Credential | DC
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Telephone | 513-313-0660
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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 | 038.011940
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License Number State | IL
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