Provider Demographics
NPI:1598921439
Name:MOYER CHIROPRACTIC
Entity Type:Organization
Organization Name:MOYER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:PHIL
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-720-7174
Mailing Address - Street 1:6301 N MERIDIAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1267
Mailing Address - Country:US
Mailing Address - Phone:405-720-7174
Mailing Address - Fax:
Practice Address - Street 1:6301 N MERIDIAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1267
Practice Address - Country:US
Practice Address - Phone:405-720-7174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty