Provider Demographics
NPI:1316237829
Name:MOYER, CHADWICK
Entity type:Individual
Prefix:
First Name:CHADWICK
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 BIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6116
Mailing Address - Country:US
Mailing Address - Phone:541-708-1595
Mailing Address - Fax:
Practice Address - Street 1:1004 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7027
Practice Address - Country:US
Practice Address - Phone:541-200-2267
Practice Address - Fax:541-200-3105
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00697171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1316237829OtherNPI
OR1417536202OtherNPI
ORAC00697OtherOREGON LICENSURE