MEDICARE: RESTORE LIFE CHIROPRACTIC LLC

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	08002857A	IN

General Provider Information

NPI Number	:	1952772469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE LIFE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1233 PARKWAY DR
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1953
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1233 PARKWAY DR
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1953
Country	:	US
Telephone Number	:	774-275-1214
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NICHOLAS JOSEPH MOORE
Credential	:	DC
Telephone Number	:	774-275-1214

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	04/13/2025

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