MEDICARE: MOORE CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5178	MN
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1083853410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	6600 FRANCE AVE S STE 206
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-1810
Country	:	US
Telephone Number	:	952-926-7515
Fax Number	:	952-926-8155

Provider Business Practice Location Address
First Line	:	6600 FRANCE AVE S STE 206
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-1810
Country	:	US
Telephone Number	:	952-926-7515
Fax Number	:	952-926-8155

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DAVID BENJAMIN JOHNSON
Credential	:	D.C.
Telephone Number	:	952-926-7515

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	12/02/2020

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