Provider Demographics
NPI:1104293117
Name:KYLE MOSER DC LLC
Entity type:Organization
Organization Name:KYLE MOSER DC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-709-5343
Mailing Address - Street 1:130 S HALCYON RD STE B
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3148
Mailing Address - Country:US
Mailing Address - Phone:805-481-8508
Mailing Address - Fax:805-481-6839
Practice Address - Street 1:130 S HALCYON RD STE B
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3148
Practice Address - Country:US
Practice Address - Phone:805-481-8508
Practice Address - Fax:805-481-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty