Provider Demographics
NPI:1144210212
Name:MOORE, JOHN RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
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 1:809 WHEELER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4367
Mailing Address - Country:US
Mailing Address - Phone:515-233-1709
Mailing Address - Fax:515-232-1917
Practice Address - Street 1:809 WHEELER ST STE 2
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4367
Practice Address - Country:US
Practice Address - Phone:515-233-1709
Practice Address - Fax:515-232-1917
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42678OtherBCBS
IA1346383619OtherGROUP NPI
IA1144210212OtherINDIVIDUAL NPI
IAIA 17029Medicaid
IA0087973Medicaid
IA42678OtherBCBS
IAT01466Medicare UPIN