Provider Demographics
NPI:1497120455
Name:RANDAL J MOYER, LLC
Entity Type:Organization
Organization Name:RANDAL J MOYER, LLC
Other - Org Name:MOYER TOTAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-756-9355
Mailing Address - Street 1:1325 S COLORADO BLVD
Mailing Address - Street 2:#B16
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3303
Mailing Address - Country:US
Mailing Address - Phone:303-756-9355
Mailing Address - Fax:
Practice Address - Street 1:1325 S COLORADO BLVD
Practice Address - Street 2:#B16
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3303
Practice Address - Country:US
Practice Address - Phone:303-756-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6071111N00000X
CO11325225700000X
CO15046225700000X
CO17967225700000X
CO11875225700000X
CO14331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty