Provider Demographics
NPI:1255585840
Name:MOORE, JOHN FERGUSON (LAC, DAHM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FERGUSON
Last Name:MOORE
Suffix:
Gender:M
Credentials:LAC, DAHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 EAST BROADWAY
Mailing Address - Street 2:SUITE 301-A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-398-5326
Mailing Address - Fax:
Practice Address - Street 1:310 E BROADWAY STE 301-A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1745
Practice Address - Country:US
Practice Address - Phone:502-398-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-09
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC152171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist