Active NPI
Clinton C. Moore, D.C.
- Chiropractor
- Locust Grove, OK
National Provider Identifier
1992813505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3649
- Practice address
- 413 E Main St
Locust Grove, OK 74352 - Phone
- (918) 479-2827
- Fax
- (918) 479-2817
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3649 | OK | Primary |
Addresses
Primary practice location
413 E Main St
Locust Grove, OK 74352
Mailing address
PO Box 1471
Locust Grove, OK 74352-1471
Phone (918) 479-2827
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3649 | OK | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992813505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1471",
"city": "LOCUST GROVE",
"state": "OK",
"postal_code": "743521471",
"telephone_number": "918-479-2827",
"fax_number": "918-479-2817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 E MAIN ST",
"city": "LOCUST GROVE",
"state": "OK",
"postal_code": "74352",
"telephone_number": "918-479-2827",
"fax_number": "918-479-2817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "CLINTON",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OK",
"license": "3649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Locust Grove, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.