Provider Demographics
NPI:1750610812
Name:MOORE, AMANDA J (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8671 NORTHPARK CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131
Mailing Address - Country:US
Mailing Address - Phone:515-278-2782
Mailing Address - Fax:515-278-0194
Practice Address - Street 1:8671 NORTHPARK CT
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131
Practice Address - Country:US
Practice Address - Phone:515-278-2782
Practice Address - Fax:515-278-0194
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011563111N00000X
IA079481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor