Provider Demographics
NPI:1063298529
Name:MOORE, CHRISTOPER (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPER
Middle Name:
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 1:2700 FARMINGTON AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4550
Mailing Address - Country:US
Mailing Address - Phone:505-564-2225
Mailing Address - Fax:505-564-2226
Practice Address - Street 1:2700 FARMINGTON AVE BLDG A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4550
Practice Address - Country:US
Practice Address - Phone:505-564-2225
Practice Address - Fax:505-564-2226
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC-2023-0007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor