Provider Demographics
NPI:1659641264
Name:MARY J MOSES DC PA
Entity Type:Organization
Organization Name:MARY J MOSES DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DC PA
Authorized Official - Phone:239-774-2444
Mailing Address - Street 1:2389 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4200
Mailing Address - Country:US
Mailing Address - Phone:239-774-2444
Mailing Address - Fax:239-774-5470
Practice Address - Street 1:2389 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4200
Practice Address - Country:US
Practice Address - Phone:239-774-2444
Practice Address - Fax:239-774-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty