Provider Demographics
NPI:1740224716
Name:MOORE, ROBYN S (DC)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:S
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 1:523 W AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3127
Mailing Address - Country:US
Mailing Address - Phone:417-667-7436
Mailing Address - Fax:417-667-7436
Practice Address - Street 1:523 W AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3127
Practice Address - Country:US
Practice Address - Phone:417-667-7436
Practice Address - Fax:417-667-7436
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001008302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000C292Medicare ID - Type Unspecified
MOU94365Medicare UPIN