Provider Demographics
NPI:1477534220
Name:MOSES, THOMAS W (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
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 1:6549 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1812
Mailing Address - Country:US
Mailing Address - Phone:313-582-5433
Mailing Address - Fax:313-582-3388
Practice Address - Street 1:6549 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1812
Practice Address - Country:US
Practice Address - Phone:313-582-5433
Practice Address - Fax:313-582-3388
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM004199111N00000X
GACHIR001566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2109682Medicaid
MIP01790004Medicare ID - Type Unspecified
MIT33815Medicare UPIN