Provider Demographics
NPI:1093888976
Name:MOZE, RANDY C (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:C
Last Name:MOZE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3563
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3563
Mailing Address - Country:US
Mailing Address - Phone:423-975-0099
Mailing Address - Fax:423-975-0996
Practice Address - Street 1:1617 W MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4903
Practice Address - Country:US
Practice Address - Phone:423-975-0099
Practice Address - Fax:423-975-0996
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2216111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation