Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 007129 | IA |
NPI | 1003051921 |
---|---|
Provider Name | Troy Moore |
First Address | Davenport, IA 52806-1647 |
Second Address | Davenport, IA 52806-1647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2008 |
Last Update Date | 05/12/2008 |