Provider Demographics
NPI:1902821002
Name:MOYER, DWIGHT PHIL (DC)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:PHIL
Last Name:MOYER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 N MERIDIAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1267
Mailing Address - Country:US
Mailing Address - Phone:405-720-7174
Mailing Address - Fax:405-720-7184
Practice Address - Street 1:6301 N MERIDIAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1267
Practice Address - Country:US
Practice Address - Phone:405-720-7174
Practice Address - Fax:405-720-7184
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3122111N00000X
TX6240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor