Provider Demographics
NPI:1578603940
Name:MOSES, TODD J (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:J
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 1:3075 WASHINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1417
Mailing Address - Country:US
Mailing Address - Phone:412-257-4252
Mailing Address - Fax:412-257-4251
Practice Address - Street 1:3075 WASHINGTON PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1417
Practice Address - Country:US
Practice Address - Phone:412-257-4252
Practice Address - Fax:412-257-4251
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006299-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01642723Medicaid
PA833403Medicare ID - Type Unspecified
PA01642723Medicaid