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General NPI Number Information
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NPI Number | 1679620082
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Entity Type | Individual
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Provider Name | JOSEPH TODD MOORE FNP, DC
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 11 EXECUTIVE WOODS CT
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City | SWANSEA
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State | IL
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Zip | 62226-2016
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Country | US
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Telephone | 618-513-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 19594 STATE HIGHWAY 14
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City | MACEDONIA
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State | IL
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Zip | 62860-1127
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Country | US
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Telephone | 618-435-3960
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Fax | 618-435-2478
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209027238
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023010527
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License Number State | MO
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