Provider Demographics
NPI:1700363900
Name:MOORE, LUKE AVERY (DC)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:AVERY
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-4704
Mailing Address - Country:US
Mailing Address - Phone:316-440-4052
Mailing Address - Fax:316-201-4331
Practice Address - Street 1:813 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4704
Practice Address - Country:US
Practice Address - Phone:316-440-4052
Practice Address - Fax:316-201-4331
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty