Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 32140 | CA |
N | 111NT0100X | Thermography | 32140 | CA |
NPI | 1003185414 |
---|---|
Provider Name | Dr. Jason William Moore |
First Address | Westlake Village, CA 91362-4019 |
Second Address | Westlake Village, CA 91362-4019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2011 |
Last Update Date | 25/01/2016 |