Healthcare Provider Details

I. General information

NPI: 1609529056
Provider Name (Legal Business Name): TYLER ANDREW MOYER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 WOODMERE PARK BLVD STE 2
VENICE FL
34293-2205
US

IV. Provider business mailing address

4140 WOODMERE PARK BLVD STE 2
VENICE FL
34293-2205
US

V. Phone/Fax

Practice location:
  • Phone: 941-497-7424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH13910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: