Provider Demographics
NPI:1508878463
Name:MOORING, STEVEN ROGER (DC, NMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROGER
Last Name:MOORING
Suffix:
Gender:M
Credentials:DC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 KACHINA DR.
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1672
Mailing Address - Country:US
Mailing Address - Phone:719-544-2009
Mailing Address - Fax:719-253-7734
Practice Address - Street 1:2505 KACHINA DR.
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1672
Practice Address - Country:US
Practice Address - Phone:719-544-2009
Practice Address - Fax:719-253-7734
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2788111NN1001X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44803Medicare ID - Type Unspecified