Healthcare Provider Details

I. General information

NPI: 1053535070
Provider Name (Legal Business Name): WILLIAM ROBERT MOYAL D.C., C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 LINCOLN RD SUITE 311
MIAMI BEACH FL
33139-2627
US

IV. Provider business mailing address

940 LINCOLN RD SUITE 311
MIAMI BEACH FL
33139-2627
US

V. Phone/Fax

Practice location:
  • Phone: 305-531-2933
  • Fax: 305-531-2393
Mailing address:
  • Phone: 305-531-2933
  • Fax: 305-531-2393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH5146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: