Provider Demographics
NPI:1003185414
Name:MOORE, JASON WILLIAM (DC, HBK)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC, HBK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31225 LA BAYA DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4019
Mailing Address - Country:US
Mailing Address - Phone:818-851-9008
Mailing Address - Fax:
Practice Address - Street 1:31225 LA BAYA DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4019
Practice Address - Country:US
Practice Address - Phone:818-851-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32140111N00000X, 111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NT0100XChiropractic ProvidersChiropractorThermography