MEDICARE: DR. SUSAN OWEN MOSS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7873	TX

General Provider Information

NPI Number	:	1053305433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN OWEN MOSS DC

Provider Business Mailing Address
First Line	:	4306 ECHO FALLS DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-1046
Country	:	US
Telephone Number	:	281-799-7291
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 ECHO FALLS DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-1046
Country	:	US
Telephone Number	:	281-799-7291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	09/16/2013

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