Provider Demographics
NPI:1720282692
Name:MOORE, JOHN-ROBERT CALVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN-ROBERT
Middle Name:CALVIN
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 1:1700 INDIAN PLAZA DR NE APT 50
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1028
Mailing Address - Country:US
Mailing Address - Phone:816-752-8562
Mailing Address - Fax:
Practice Address - Street 1:1900 CARLISLE BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4964
Practice Address - Country:US
Practice Address - Phone:505-266-6200
Practice Address - Fax:505-266-6883
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor