Provider Demographics
NPI:1922419969
Name:MOODY, JOHN PAUL III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:MOODY
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2389 RENAISSANCE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6106
Mailing Address - Country:US
Mailing Address - Phone:170-245-8149
Mailing Address - Fax:170-245-8786
Practice Address - Street 1:2389 RENAISSANCE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6106
Practice Address - Country:US
Practice Address - Phone:170-245-8149
Practice Address - Fax:170-245-8786
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVB-00793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor