Healthcare Provider Details

I. General information

NPI: 1457536237
Provider Name (Legal Business Name): MOSCOW CHIROPRACTIC LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 S TUTTLE AVE STE 1
SARASOTA FL
34237-8107
US

IV. Provider business mailing address

1071 S TUTTLE AVE STE 1
SARASOTA FL
34237-8107
US

V. Phone/Fax

Practice location:
  • Phone: 941-954-3700
  • Fax: 941-296-8202
Mailing address:
  • Phone: 941-954-3700
  • Fax: 941-296-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8809
License Number StateFL

VIII. Authorized Official

Name: LOUISA CHENG MOSCOW
Title or Position: OFFICE MANAGER
Credential:
Phone: 941-954-3700