=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619108917
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL AILI MOORE D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2009
-----------------------------------------------------
Last Update Date | 08/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2125 E HENNEPIN AVE STE 300
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55413-1763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-750-7168
-----------------------------------------------------
Fax | 612-564-7373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2125 E HENNEPIN AVE STE 300
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55413-1763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-750-7168
-----------------------------------------------------
Fax | 612-564-7373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5260
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------