Provider Demographics
NPI:1225005994
Name:MOSES, MARY JEAN (DC PA)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:MOSES
Suffix:
Gender:F
Credentials:DC PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2389 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104
Mailing Address - Country:US
Mailing Address - Phone:239-774-2444
Mailing Address - Fax:239-774-5470
Practice Address - Street 1:2389 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104
Practice Address - Country:US
Practice Address - Phone:239-774-2444
Practice Address - Fax:239-774-5470
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
55696OtherBCBS
650824023OtherTAX ID
FL55696Medicare ID - Type Unspecified
U74825Medicare UPIN