Provider Demographics
NPI:1306440276
Name:MOORE, DAVID F (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
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 1:225 W HUBBARD ST
Mailing Address - Street 2:STE 302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4916
Mailing Address - Country:US
Mailing Address - Phone:630-880-3845
Mailing Address - Fax:
Practice Address - Street 1:1N210 TAMARACK DR
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2054
Practice Address - Country:US
Practice Address - Phone:630-880-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor