Provider Demographics
NPI:1760515456
Name:MOSHER, DAVID PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PETER
Last Name:MOSHER
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 1:6205 DR MARTIN LUTHER KING JR ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5608
Mailing Address - Country:US
Mailing Address - Phone:727-864-1701
Mailing Address - Fax:727-866-6178
Practice Address - Street 1:6205 DR MARTIN LUTHER KING JR ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5608
Practice Address - Country:US
Practice Address - Phone:727-864-1701
Practice Address - Fax:727-866-6178
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor