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NPI Code Detail

MEDICARE: DR. JOHANNA STUART MARY MOSES D.C.

MEDICARE: DR. JOHANNA STUART MARY MOSES D.C.
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
1111N00000XChiropractorX004611-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C04611-2OTHERNYNYS WORKERS COMPENSATION

General Provider Information

NPI Number : 1902982994
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHANNA STUART MARY MOSES D.C.
Provider Business Mailing Address
First Line : 6578 NEW YORK STATE ROUTE 12
Second Line :
City : NORWICH
State : NY
Zip : 13815-0000
Country : US
Telephone Number : 607-334-4703
Fax Number : 607-334-4703
Provider Business Practice Location Address
First Line : 6578 NEW YORK STATE ROUTE 12
Second Line :
City : NORWICH
State : NY
Zip : 13815-0000
Country : US
Telephone Number : 607-334-4703
Fax Number : 607-334-4703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/08/2007

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