Provider Demographics
NPI:1548211394
Name:MOORE, CHRIS ALAN (RD)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:ALAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 LOS MISIONEROS
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9018
Mailing Address - Country:US
Mailing Address - Phone:505-521-5901
Mailing Address - Fax:509-355-8154
Practice Address - Street 1:2611 LOS MISIONEROS
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9018
Practice Address - Country:US
Practice Address - Phone:505-521-5901
Practice Address - Fax:509-355-8154
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM805015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered