Provider Demographics
NPI:1447784111
Name:MO'HYLA, MADELINE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:MARIE
Last Name:MO'HYLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2857 BAY ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-8631
Mailing Address - Country:US
Mailing Address - Phone:941-315-3715
Mailing Address - Fax:
Practice Address - Street 1:777 S PALM AVE UNIT 8
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7746
Practice Address - Country:US
Practice Address - Phone:941-400-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor