Provider Demographics
NPI:1972512531
Name:MOSS, RANDELL WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:RANDELL
Middle Name:WAYNE
Last Name:MOSS
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 1:821 N. NOLAN RIVER RD.
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033
Mailing Address - Country:US
Mailing Address - Phone:817-641-4042
Mailing Address - Fax:817-645-4357
Practice Address - Street 1:821 N. NOLAN RIVER RD.
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033
Practice Address - Country:US
Practice Address - Phone:817-641-4042
Practice Address - Fax:817-645-4357
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4361073OtherAETNA
TX350027566OtherRAIL ROAD MEDICARE
TX8A7230OtherBLUE CROSS BLUE SHIELD
TX8A7230OtherBLUE CROSS BLUE SHIELD
TX350027566OtherRAIL ROAD MEDICARE