Provider Demographics
NPI:1134498231
Name:JASON D MOYLE, PLLC
Entity Type:Organization
Organization Name:JASON D MOYLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-219-7139
Mailing Address - Street 1:3275 W INA RD
Mailing Address - Street 2:STE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2151
Mailing Address - Country:US
Mailing Address - Phone:520-861-8109
Mailing Address - Fax:520-297-8838
Practice Address - Street 1:3275 W INA RD
Practice Address - Street 2:STE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2151
Practice Address - Country:US
Practice Address - Phone:520-219-7139
Practice Address - Fax:520-297-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1255525887OtherNPI TYPE 1