Healthcare Provider Details

I. General information

NPI: 1184760878
Provider Name (Legal Business Name): KAHLIL VADRE MOSES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KAHLIL VADRE MOSES .D.C

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 US HIGHWAY 1 SUITE B
NORTH PALM BEACH FL
33408-4500
US

IV. Provider business mailing address

700 US HIGHWAY 1 SUITE B
NORTH PALM BEACH FL
33408-4500
US

V. Phone/Fax

Practice location:
  • Phone: 561-848-8482
  • Fax: 954-963-7169
Mailing address:
  • Phone: 561-848-8482
  • Fax: 954-963-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: