Provider Demographics
NPI:1326009085
Name:MOYLAN, JAMES EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:MOYLAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37503
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-7503
Mailing Address - Country:US
Mailing Address - Phone:267-324-3461
Mailing Address - Fax:267-324-3464
Practice Address - Street 1:1301 S 3RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-6008
Practice Address - Country:US
Practice Address - Phone:267-324-3461
Practice Address - Fax:267-324-3464
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004382L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA642268Medicare ID - Type Unspecified