Provider Demographics
NPI:1790731917
Name:MOORE, JOHN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
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 1:6723 MORNINGSIDE DR.
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-6063
Mailing Address - Country:US
Mailing Address - Phone:740-549-0091
Mailing Address - Fax:740-549-0091
Practice Address - Street 1:8570 COTTER ST
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7137
Practice Address - Country:US
Practice Address - Phone:614-781-3139
Practice Address - Fax:614-781-7816
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0858255Medicaid
OH0831731Medicare PIN
OHU67217Medicare UPIN