Provider Demographics
NPI:1740220912
Name:MOSER, JON J (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:J
Last Name:MOSER
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 1:533 W UWCHLAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1763
Mailing Address - Country:US
Mailing Address - Phone:484-593-0328
Mailing Address - Fax:484-593-0440
Practice Address - Street 1:533 W UWCHLAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-1763
Practice Address - Country:US
Practice Address - Phone:484-593-0328
Practice Address - Fax:484-593-0440
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC450526577111N00000X
PADC003773L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7865Medicare ID - Type Unspecified