Healthcare Provider Details

I. General information

NPI: 1093888976
Provider Name (Legal Business Name): RANDY C MOZE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 W MARKET ST STE A
JOHNSON CITY TN
37604-4903
US

IV. Provider business mailing address

PO BOX 3563
JOHNSON CITY TN
37602-3563
US

V. Phone/Fax

Practice location:
  • Phone: 423-975-0099
  • Fax: 423-975-0996
Mailing address:
  • Phone: 423-975-0099
  • Fax: 423-975-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2216
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: