Provider Demographics
NPI:1083656565
Name:MOULDS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MOULDS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-449-8855
Mailing Address - Street 1:6266 N W ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-1903
Mailing Address - Country:US
Mailing Address - Phone:850-465-3252
Mailing Address - Fax:850-465-3254
Practice Address - Street 1:6266 N W ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-1903
Practice Address - Country:US
Practice Address - Phone:850-465-3252
Practice Address - Fax:850-465-3254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM13927225700000X
FLCH8429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM13927OtherSTATE LICENSE
FL381696600Medicaid
FLCH8429OtherSTATE LICENSE
FLCH8429OtherSTATE LICENSE
76965AMedicare ID - Type Unspecified