Provider Demographics
NPI:1083786057
Name:MOORE, CHRISTOPHER TODD (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 W 220 S
Mailing Address - Street 2:STE 201
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2990
Mailing Address - Country:US
Mailing Address - Phone:801-787-2354
Mailing Address - Fax:801-785-9529
Practice Address - Street 1:348 E STATE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3617
Practice Address - Country:US
Practice Address - Phone:801-785-7874
Practice Address - Fax:801-785-9529
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5561407-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTV08131Medicare UPIN