Healthcare Provider Details

I. General information

NPI: 1679558134
Provider Name (Legal Business Name): DAVID EARL MOSS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N PAW PAW ST
COLOMA MI
49038-9567
US

IV. Provider business mailing address

PO BOX 224
COLOMA MI
49038-0224
US

V. Phone/Fax

Practice location:
  • Phone: 269-468-5775
  • Fax: 269-468-3447
Mailing address:
  • Phone: 269-468-5775
  • Fax: 269-468-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: