Provider Demographics
NPI:1073991998
Name:MOSES, DUSTIN H (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:H
Last Name:MOSES
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 1:15945 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9342
Mailing Address - Country:US
Mailing Address - Phone:913-766-7292
Mailing Address - Fax:913-766-3780
Practice Address - Street 1:15945 W 65TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9342
Practice Address - Country:US
Practice Address - Phone:913-766-7292
Practice Address - Fax:913-766-3780
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor