Provider Demographics
NPI:1689088791
Name:MOYLAN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MOYLAN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-324-3461
Mailing Address - Street 1:1301 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6008
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004382L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001277057Medicaid
PA001277057Medicaid