Provider Demographics
NPI:1629258587
Name:JENNIFER MOORE DC INC
Entity Type:Organization
Organization Name:JENNIFER MOORE DC INC
Other - Org Name:ATLAS FAMILY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DR. OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-895-4444
Mailing Address - Street 1:3538 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3315
Mailing Address - Country:US
Mailing Address - Phone:708-895-4444
Mailing Address - Fax:
Practice Address - Street 1:3538 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3315
Practice Address - Country:US
Practice Address - Phone:708-895-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208989Medicare PIN