Provider Demographics
NPI:1184760878
Name:MOSES, KAHLIL VADRE (DC)
Entity type:Individual
Prefix:DR
First Name:KAHLIL
Middle Name:VADRE
Last Name:MOSES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KAHLIL
Other - Middle Name:VADRE
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:700 US HIGHWAY 1
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4500
Mailing Address - Country:US
Mailing Address - Phone:561-848-8482
Mailing Address - Fax:954-963-7169
Practice Address - Street 1:700 US HIGHWAY 1
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4500
Practice Address - Country:US
Practice Address - Phone:561-848-8482
Practice Address - Fax:954-963-7169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89044OtherBLUE CROSS BLUE SHEILD
FL205626090OtherTAX ID