Provider Demographics
NPI:1487309118
Name:MOORE, MARCUS RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:RYAN
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 1:833 MEANDER CT
Mailing Address - Street 2:
Mailing Address - City:HAMEL
Mailing Address - State:MN
Mailing Address - Zip Code:55340-4549
Mailing Address - Country:US
Mailing Address - Phone:612-470-0635
Mailing Address - Fax:
Practice Address - Street 1:833 MEANDER CT
Practice Address - Street 2:
Practice Address - City:HAMEL
Practice Address - State:MN
Practice Address - Zip Code:55340-4549
Practice Address - Country:US
Practice Address - Phone:612-470-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor