Provider Demographics
NPI:1386213551
Name:MOORE, RANDY E (DC RDMSCRMSK)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC RDMSCRMSK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 W 100 S
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3739
Mailing Address - Country:US
Mailing Address - Phone:513-708-0585
Mailing Address - Fax:
Practice Address - Street 1:758 W 100 S
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3739
Practice Address - Country:US
Practice Address - Phone:513-708-0585
Practice Address - Fax:435-915-7223
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12108828-1202111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12108828-1202OtherCHIROPRACTIC LICENSE