MEDICARE: NON-SURGICAL BACK SOLUTIONS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC002678L	PA

General Provider Information

NPI Number	:	1023212867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NON-SURGICAL BACK SOLUTIONS INC

Provider Business Mailing Address
First Line	:	4024 TYSON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1608
Country	:	US
Telephone Number	:	215-333-3322
Fax Number	:	215-333-6867

Provider Business Practice Location Address
First Line	:	4024 TYSON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1608
Country	:	US
Telephone Number	:	215-333-3322
Fax Number	:	215-333-6867

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	LARRY MOSES
Credential	:
Telephone Number	:	215-333-3322

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	08/22/2020

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