Provider Demographics
NPI:1346365749
Name:MOORE, JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
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 1:1330 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1907
Mailing Address - Country:US
Mailing Address - Phone:954-384-3275
Mailing Address - Fax:954-446-6590
Practice Address - Street 1:1330 SW 160TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1907
Practice Address - Country:US
Practice Address - Phone:954-384-3275
Practice Address - Fax:954-446-6590
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3212111N00000X
FLCH9974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085T4Medicaid
NC2456915Medicare PIN