Provider Demographics
NPI:1053535070
Name:MOYAL, WILLIAM ROBERT (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MOYAL
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 LINCOLN RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2627
Mailing Address - Country:US
Mailing Address - Phone:305-531-2933
Mailing Address - Fax:305-531-2393
Practice Address - Street 1:940 LINCOLN RD
Practice Address - Street 2:SUITE 311
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2627
Practice Address - Country:US
Practice Address - Phone:305-531-2933
Practice Address - Fax:305-531-2393
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5146111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU25989Medicare UPIN
FL70844Medicare ID - Type Unspecified