Provider Demographics
NPI:1043632607
Name:JAMES R. MULDOON DC PLLC
Entity Type:Organization
Organization Name:JAMES R. MULDOON DC PLLC
Other - Org Name:NEUROLOGIC CHIROPRACTIC CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:MULDOON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-892-7246
Mailing Address - Street 1:29680 S WIXOM RD
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-3430
Mailing Address - Country:US
Mailing Address - Phone:248-892-7246
Mailing Address - Fax:248-869-6000
Practice Address - Street 1:29680 S WIXOM RD
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3430
Practice Address - Country:US
Practice Address - Phone:248-892-7246
Practice Address - Fax:248-869-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1125003Medicare PIN