Provider Demographics
NPI:1013564012
Name:MOODY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOODY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:702-525-1027
Mailing Address - Street 1:2654 W HORIZON RIDGE PKWY STE B1
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2863
Mailing Address - Country:US
Mailing Address - Phone:702-458-1495
Mailing Address - Fax:702-458-7869
Practice Address - Street 1:2654 W HORIZON RIDGE PKWY STE B1
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2863
Practice Address - Country:US
Practice Address - Phone:702-458-1495
Practice Address - Fax:702-458-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty