Provider Demographics
NPI:1346300803
Name:MOORE, DAVID R (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:850 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1716
Mailing Address - Country:US
Mailing Address - Phone:973-253-7005
Mailing Address - Fax:973-246-9299
Practice Address - Street 1:850 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1716
Practice Address - Country:US
Practice Address - Phone:973-253-7005
Practice Address - Fax:973-246-9299
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00543200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ028058Medicare ID - Type Unspecified