Provider Demographics
NPI:1518174051
Name:MOSS, RUBEN R (DC)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:R
Last Name:MOSS
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 1:9526 NE 2ND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2750
Mailing Address - Country:US
Mailing Address - Phone:305-756-7246
Mailing Address - Fax:305-754-1172
Practice Address - Street 1:9526 NE 2ND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2750
Practice Address - Country:US
Practice Address - Phone:305-756-7246
Practice Address - Fax:305-754-1172
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006256111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU09460Medicare UPIN
FL22579Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER