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General NPI Number Information
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NPI Number | 1467866087
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Entity Type | Organization
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Legal Business Name | KEYSTONE SPECIFIC CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 676 OLD SWEDE RD
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City | DOUGLASSVILLE
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State | PA
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Zip | 19518-9661
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Country | US
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Telephone | 610-914-9319
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Fax |
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Provider Business Mailing Address
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Address Line | 676 OLD SWEDE RD
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City | DOUGLASSVILLE
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State | PA
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Zip | 19518-9661
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Country | US
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Telephone | 610-914-9319
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. WILLIAM A. MOSS
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Credential |
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Telephone | 610-914-9319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC010666
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License Number State | PA
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