Individual provider Active NPI

Kevin Joel Moore, DC

  • Chiropractor
  • Davenport, IA
National Provider Identifier
1023069176
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
AO6100 Issued in IA
Practice address
3420 Elmore Ave
Davenport, IA 52807-2594
Phone
(563) 344-6060
Fax
(563) 344-6061
NPI assigned
May 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X AO6100 IA Primary

Addresses

Primary practice location

3420 Elmore Ave
Davenport, IA 52807-2594

Mailing address

2260 Highway 30
Grand Mound, IA 52751-9509
Phone (563) 210-2839

Other identifiers 1

IdentifierTypeStateIssuer
1210096MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071205000729 TN Practitioner - Chiropractic 2567400203 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AO6100IAMDChiropractor
2218TNMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tennessee Valley Clinic of Chiropractic PC CurrentSince Jul 1, 2009 Accepting new patients

Locations

304 1st Ave
Dayton, TN 37321
Phone (423) 775-6688

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1023069176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 HIGHWAY 30",
            "city": "GRAND MOUND",
            "state": "IA",
            "postal_code": "527519509",
            "telephone_number": "563-210-2839",
            "fax_number": "563-344-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 ELMORE AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072594",
            "telephone_number": "563-344-6060",
            "fax_number": "563-344-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KEVIN",
        "middle_name": "JOEL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "AO6100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1210096",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.