Provider Demographics
NPI:1992718506
Name:MOORE, RICHARD S (DC CHIROPRACTOR)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:MOORE
Suffix:
Gender:M
Credentials:DC CHIROPRACTOR
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:S
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:114 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 SILVER ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-749-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH145A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30250174Medicaid
NH8627Medicare ID - Type Unspecified