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General NPI Number Information
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NPI Number | 1093888976
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Entity Type | Individual
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Provider Name | RANDY C MOZE D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 1617 W MARKET ST STE A
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4903
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Country | US
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Telephone | 423-975-0099
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Fax | 423-975-0996
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Provider Business Mailing Address
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Address Line | PO BOX 3563
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City | JOHNSON CITY
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State | TN
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Zip | 37602-3563
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Country | US
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Telephone | 423-975-0099
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Fax | 423-975-0996
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2216
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License Number State | TN
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