Individual
DR. JEFFREY MICHAEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
333 COMMERCE DR STE 175, CRYSTAL LAKE, IL 60014-3596
(815) 245-4624
Mailing address
333 COMMERCE DR STE 175, CRYSTAL LAKE, IL 60014-3596
(815) 245-4624
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-004398
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038-004398
LISCENSE TO PRACTICE CHIR
IL
01
—
05632146
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/19/2006
Last updated
07/21/2022
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