Provider Demographics
NPI:1154553402
Name:MOODY CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:MOODY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-777-8450
Mailing Address - Street 1:2909 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3048
Mailing Address - Country:US
Mailing Address - Phone:336-777-8450
Mailing Address - Fax:336-777-8435
Practice Address - Street 1:2909 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3048
Practice Address - Country:US
Practice Address - Phone:336-777-8450
Practice Address - Fax:336-777-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3997261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center