Provider Demographics
NPI:1730228529
Name:MOORE CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:MOORE CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-294-2828
Mailing Address - Street 1:30 W RAHN RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2291
Mailing Address - Country:US
Mailing Address - Phone:937-294-2828
Mailing Address - Fax:937-434-7603
Practice Address - Street 1:30 W RAHN RD
Practice Address - Street 2:SUITE 28
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2291
Practice Address - Country:US
Practice Address - Phone:937-294-2828
Practice Address - Fax:937-434-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========00OtherBWC GROUP NUMBER
OH=========00OtherBWC GROUP NUMBER