Provider Demographics
NPI:1518077973
Name:THOMAS W MOSES DC PC
Entity Type:Organization
Organization Name:THOMAS W MOSES DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-582-5433
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM004199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P01790Medicare ID - Type Unspecified