Healthcare Provider Details

I. General information

NPI: 1083656565
Provider Name (Legal Business Name): MOULDS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6266 N W ST
PENSACOLA FL
32505-1903
US

IV. Provider business mailing address

6266 N W ST
PENSACOLA FL
32505-1903
US

V. Phone/Fax

Practice location:
  • Phone: 850-465-3252
  • Fax: 850-465-3254
Mailing address:
  • Phone: 850-465-3252
  • Fax: 850-465-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8429
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMM13927
License Number StateFL

VIII. Authorized Official

Name: DR. RYAN MOULDS
Title or Position: OWNER
Credential: D.C.
Phone: 850-449-8855