Provider Demographics
NPI:1770759557
Name:MOORE, JEFFERY (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0901
Mailing Address - Country:US
Mailing Address - Phone:406-259-5096
Mailing Address - Fax:406-248-5655
Practice Address - Street 1:720 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0901
Practice Address - Country:US
Practice Address - Phone:406-259-5096
Practice Address - Fax:406-248-5655
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT113175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath