Provider Demographics
NPI:1821867748
Name:MOORE, JARYD W (DC)
Entity Type:Individual
Prefix:DR
First Name:JARYD
Middle Name:W
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 1:1913 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-5303
Mailing Address - Country:US
Mailing Address - Phone:620-221-1990
Mailing Address - Fax:620-221-4523
Practice Address - Street 1:1913 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-5303
Practice Address - Country:US
Practice Address - Phone:620-221-1990
Practice Address - Fax:620-221-4523
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor