Individual
KEVIN PATRICK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2604 DEMPSTER ST, STE 304, PARK RIDGE, IL 60068-8412
(847) 635-8080
(847) 390-8080
Mailing address
2604 DEMPSTER ST, STE 304, PARK RIDGE, IL 60068-8412
(847) 635-8080
(847) 390-8080
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-005366
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016-36062
BLUE CROSS BLUE SHIELD
IL
01
—
1649460270
CORPORATE NPI
IL
01
—
K14265
MEDICARE MEMBER NUMBER
—
Enumeration date
11/10/2006
Last updated
03/30/2023
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