Healthcare Provider Details

I. General information

NPI: 1598605784
Provider Name (Legal Business Name): MOODY CHIROPRACTIC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2963 GULF TO BAY BLVD STE 206
CLEARWATER FL
33759-4200
US

IV. Provider business mailing address

1551 FLOURNOY CIR W APT 10117
CLEARWATER FL
33764-1409
US

V. Phone/Fax

Practice location:
  • Phone: 402-415-3661
  • Fax:
Mailing address:
  • Phone: 402-415-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY JUSTIN MOODY
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 402-415-3661