Provider Demographics
NPI:1619108917
Name:MOORE, RACHEL AILI (DC)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:AILI
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 E HENNEPIN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1763
Mailing Address - Country:US
Mailing Address - Phone:612-750-7168
Mailing Address - Fax:612-564-7373
Practice Address - Street 1:2125 E HENNEPIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1763
Practice Address - Country:US
Practice Address - Phone:612-750-7168
Practice Address - Fax:612-564-7373
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor