Provider Demographics
NPI:1982783130
Name:MOORE, KRIS ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:ALLEN
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 1:5242 PLAINFIELD AVE NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1084
Mailing Address - Country:US
Mailing Address - Phone:616-447-9972
Mailing Address - Fax:616-447-4140
Practice Address - Street 1:5242 PLAINFIELD AVE NE
Practice Address - Street 2:SUITE E
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1084
Practice Address - Country:US
Practice Address - Phone:616-447-9972
Practice Address - Fax:616-447-4140
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKM007742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4679736Medicaid
MI4679736Medicaid
MI0N86120Medicare UPIN
MIN8612001Medicare ID - Type Unspecified