Provider Demographics
NPI:1083853410
Name:MOORE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MOORE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-926-7515
Mailing Address - Street 1:6600 FRANCE AVE S STE 206
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1810
Mailing Address - Country:US
Mailing Address - Phone:952-926-7515
Mailing Address - Fax:952-926-8155
Practice Address - Street 1:6600 FRANCE AVE S STE 206
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1810
Practice Address - Country:US
Practice Address - Phone:952-926-7515
Practice Address - Fax:952-926-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5178111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty