MEDICARE: DR. AMANDA J MOORE D.C.

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	079481	IA
2	111N00000X	Chiropractor	DC-1425	HI
3	111N00000X	Chiropractor	038011563	IL

General Provider Information

NPI Number	:	1750610812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA J MOORE D.C.

Provider Business Mailing Address
First Line	:	30 E LIPOA ST
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-5821
Country	:	US
Telephone Number	:	808-270-2530
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 E LIPOA ST
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-5821
Country	:	US
Telephone Number	:	808-270-2520
Fax Number	:

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

Provider Enumeration Date	:	12/18/2009
Last Update Date	:	02/03/2026

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