Provider Demographics
NPI:1952633406
Name:MOORE, DON JUAN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:JUAN
Last Name:MOORE
Suffix:JR
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 1:1970-6 RT 112
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727
Mailing Address - Country:US
Mailing Address - Phone:631-451-1515
Mailing Address - Fax:631-451-1616
Practice Address - Street 1:1970 ROUTE 112 STE 6
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2300
Practice Address - Country:US
Practice Address - Phone:631-451-1515
Practice Address - Fax:631-451-1616
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor