Provider Demographics
NPI:1093835126
Name:MOORE, JOHN W (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
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 1:822 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3868
Mailing Address - Country:US
Mailing Address - Phone:765-288-4769
Mailing Address - Fax:765-284-8595
Practice Address - Street 1:822 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3868
Practice Address - Country:US
Practice Address - Phone:765-288-4769
Practice Address - Fax:765-284-8595
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100106680AMedicaid
IN207320Medicare ID - Type Unspecified