Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | B01456 | NV |
N | 111NN1001X | Nutrition | B01456 | NV |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | B01456 | NV |
NPI | 1164796207 |
---|---|
Provider Name | Robert Raymond Moore |
First Address | Las Vegas, NV 89110-6349 |
Second Address | Las Vegas, NV 89131-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2012 |
Last Update Date | 21/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126002 | BOARD OF CHIROPRACTIC EXAMINERS (01) | IA |