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General NPI Number Information
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NPI Number | 1154553402
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Entity Type | Organization
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Legal Business Name | MOODY CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 2909 REYNOLDA RD
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3048
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Country | US
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Telephone | 336-777-8450
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Fax | 336-777-8435
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Provider Business Mailing Address
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Address Line | 2909 REYNOLDA RD
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3048
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Country | US
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Telephone | 336-777-8450
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Fax | 336-777-8435
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM EDWARD MOODY
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Credential | D.C.
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Telephone | 336-777-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3997
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License Number State | NC
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