Faxon D Moulder, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2774319-41202 Issued in UT

Practice address

66 E State Rd
Pleasant Grove, UT 84062-2637

Phone

(801) 796-7961

Fax

(801) 796-1104

NPI assigned

Nov 3, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427137371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 E STATE RD",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840622637",
            "telephone_number": "801-796-7961",
            "fax_number": "801-796-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 E STATE RD",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840622637",
            "telephone_number": "801-796-7961",
            "fax_number": "801-796-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULDER",
        "first_name": "FAXON",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "2774319-41202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Moore, L.C.S.W.
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• Donald Scott Mortensen, PHARM.D
• Lisa Mortensen, MS ATC
• Mothers Lounge, LLC
• Geoffrey Moultrie, D.C.
• Mount Mahogany PC
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• Mountain View Family Counseling
• Mt Grove Counseling LLC

• Chiropractor in Pleasant Grove, UT
• Providers in Pleasant Grove, UT by specialty
• Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.