Healthcare Provider Details

I. General information

NPI: 1326009085
Provider Name (Legal Business Name): JAMES EDWARD MOYLAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S 3RD ST
PHILADELPHIA PA
19147-6008
US

IV. Provider business mailing address

PO BOX 37503
PHILADELPHIA PA
19148-7503
US

V. Phone/Fax

Practice location:
  • Phone: 267-324-3461
  • Fax: 267-324-3464
Mailing address:
  • Phone: 267-324-3461
  • Fax: 267-324-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number004382L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: