Healthcare Provider Details

I. General information

NPI: 1912229840
Provider Name (Legal Business Name): JAYME LYNN MOULTON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAYME LYNN CLAYTON DC

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 COMMERCE BLVD
MOUND MN
55364-1493
US

IV. Provider business mailing address

2305 COMMERCE BLVD
MOUND MN
55364-1493
US

V. Phone/Fax

Practice location:
  • Phone: 952-471-2560
  • Fax: 952-471-2465
Mailing address:
  • Phone: 952-471-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5307
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: