MEDICARE: DR. JEFFREY MICHAEL MOORE DC

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	038-004398	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	038-004398	OTHER	IL	LISCENSE TO PRACTICE CHIR
2	05632146	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1538273909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY MICHAEL MOORE DC

Provider Business Mailing Address
First Line	:	333 COMMERCE DR STE 175
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3596
Country	:	US
Telephone Number	:	815-245-4624
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 COMMERCE DR STE 175
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3596
Country	:	US
Telephone Number	:	815-245-4624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/21/2022

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