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General NPI Number Information
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NPI Number | 1730377490
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Entity Type | Organization
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Legal Business Name | MOSES FAMILY CHIROPRACTIC & WELLNESS CENTER, P.C.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 45941 HAYES RD
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-6217
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Country | US
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Telephone | 586-323-5060
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Fax | 586-323-5062
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Provider Business Mailing Address
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Address Line | PO BOX 183051
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48318-3051
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Country | US
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Telephone | 586-323-5060
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Fax | 586-323-5062
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK ALONZO MOSES JR.
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Credential | D.C.
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Telephone | 586-323-5060
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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 | 2301008704
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License Number State | MI
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