Provider Demographics
NPI:1316168271
Name:JASON A. MOORE, D.C. PLLC
Entity type:Organization
Organization Name:JASON A. MOORE, D.C. PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-523-7891
Mailing Address - Street 1:2511 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1810
Mailing Address - Country:US
Mailing Address - Phone:304-523-7891
Mailing Address - Fax:304-523-7894
Practice Address - Street 1:2511 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1614
Practice Address - Country:US
Practice Address - Phone:304-523-7891
Practice Address - Fax:304-523-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV819261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV003810001016Medicaid
WV001767587OtherBLUE CROSS BLUE SHIELD
WV001767587OtherBLUE CROSS BLUE SHIELD