Provider Demographics
NPI:1235842501
Name:MOORHEAD, ROBERT B
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:MOORHEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E CRANSTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CO
Mailing Address - Zip Code:81039-1125
Mailing Address - Country:US
Mailing Address - Phone:719-299-1607
Mailing Address - Fax:
Practice Address - Street 1:112 E CRANSTON AVE STE A
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CO
Practice Address - Zip Code:81039-1125
Practice Address - Country:US
Practice Address - Phone:719-299-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR0008592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor