Provider Demographics
NPI:1871667691
Name:MOORE, JASON ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALAN
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 1:2511 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1614
Mailing Address - Country:US
Mailing Address - Phone:304-523-7891
Mailing Address - Fax:304-523-7894
Practice Address - Street 1:2511 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2809
Practice Address - Country:US
Practice Address - Phone:304-523-7891
Practice Address - Fax:304-523-7894
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001016Medicaid
WV3810001016Medicaid