Basic Information
| Provider Information | |||||||||
| NPI: | 1982982914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | KRISTIN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | L.AC., DOM (NM) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7306 S 12TH PL | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850425684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053146767 | ||||||||
| FaxNumber: | 4807591669 | ||||||||
| Practice Location | |||||||||
| Address1: | 3233 E CHANDLER BLVD STE 3 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807591668 | ||||||||
| FaxNumber: | 4807591669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2011 | ||||||||
| LastUpdateDate: | 01/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 1052 | NM | N | Other Service Providers | Acupuncturist | 171100000X | 0843 | AZ | Y | Other Service Providers | Acupuncturist |
No ID Information.