Provider Demographics
NPI:1043309511
Name:MOSSO, CARL RICHARD (DC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:RICHARD
Last Name:MOSSO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 N PALM AIRE DR
Mailing Address - Street 2:#205
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069
Mailing Address - Country:US
Mailing Address - Phone:954-917-4095
Mailing Address - Fax:954-917-4095
Practice Address - Street 1:3155 N PALM AIRE DR
Practice Address - Street 2:#205
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:954-917-4095
Practice Address - Fax:954-917-4095
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL006643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55143OtherBLUE CROSS BLUE SHIELD
FL55143Medicare ID - Type Unspecified