Healthcare Provider Details

I. General information

NPI: 1578558466
Provider Name (Legal Business Name): PAUL A. MOYSE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MONROE TPKE SUITE 102
MONROE CT
06468-2343
US

IV. Provider business mailing address

450 MONROE TPKE SUITE 102
MONROE CT
06468-2343
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-1355
  • Fax:
Mailing address:
  • Phone: 203-261-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number437
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: