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General NPI Number Information
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NPI Number | 1528669900
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Entity Type | Individual
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Provider Name | AUSTIN MOON DC
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Gender | Male
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1933 S NARCOOSSEE RD
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City | SAINT CLOUD
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State | FL
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Zip | 34771-7211
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Country | US
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Telephone | 401-498-4052
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Fax |
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Provider Business Mailing Address
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Address Line | 9537 LONGVIEW DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2407
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Country | US
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Telephone | 443-759-0171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | S04085
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License Number State | MD
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