Healthcare Provider Details

I. General information

NPI: 1497120455
Provider Name (Legal Business Name): RANDAL J MOYER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S COLORADO BLVD #B16
DENVER CO
80222-3303
US

IV. Provider business mailing address

1325 S COLORADO BLVD #B16
DENVER CO
80222-3303
US

V. Phone/Fax

Practice location:
  • Phone: 303-756-9355
  • Fax:
Mailing address:
  • Phone: 303-756-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6071
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11325
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15046
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17967
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11875
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14331
License Number StateCO

VIII. Authorized Official

Name: RANDAL JAMES MOYER
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 303-756-9355