Provider Demographics
NPI:1578558466
Name:MOYSE, PAUL A (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:MOYSE
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 1:450 MONROE TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2343
Mailing Address - Country:US
Mailing Address - Phone:203-261-1355
Mailing Address - Fax:
Practice Address - Street 1:450 MONROE TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2343
Practice Address - Country:US
Practice Address - Phone:203-261-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT437111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT35000350Medicare PIN