1184760878 NPI number — DR. KAHLIL VADRE MOSES D.C.

Table of content: DR. KAHLIL VADRE MOSES D.C. (NPI 1184760878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184760878 NPI number — DR. KAHLIL VADRE MOSES D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSES
Provider First Name:
KAHLIL
Provider Middle Name:
VADRE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSES
Provider Other First Name:
KAHLIL
Provider Other Middle Name:
VADRE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
.D.C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184760878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 US HIGHWAY 1
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
NORTH PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33408-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-848-8482
Provider Business Mailing Address Fax Number:
954-963-7169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 US HIGHWAY 1
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTH PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33408-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-848-8482
Provider Business Practice Location Address Fax Number:
954-963-7169
Provider Enumeration Date:
01/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8298 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89044 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 205626090 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".