Provider Demographics
NPI:1528562428
Name:MOSS, LAUREN GRACE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:GRACE
Last Name:MOSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 WASHINGTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9716
Mailing Address - Country:US
Mailing Address - Phone:724-229-5266
Mailing Address - Fax:
Practice Address - Street 1:1385 WASHINGTON RD STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9674
Practice Address - Country:US
Practice Address - Phone:724-229-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor