Provider Demographics
NPI:1568902047
Name:MOULTON, KAEL (DC)
Entity type:Individual
Prefix:
First Name:KAEL
Middle Name:
Last Name:MOULTON
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 KIRKWOOD BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1530
Mailing Address - Country:US
Mailing Address - Phone:817-251-7250
Mailing Address - Fax:817-382-2706
Practice Address - Street 1:2131 KIRKWOOD BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1530
Practice Address - Country:US
Practice Address - Phone:817-251-7250
Practice Address - Fax:817-382-2706
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor