Provider Demographics
NPI:1023036258
Name:MOSES, SUSAN GAIL (DC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAIL
Last Name:MOSES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 OREILLY DR STE A
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7327
Mailing Address - Country:US
Mailing Address - Phone:215-624-9222
Mailing Address - Fax:
Practice Address - Street 1:1325 OREILLY DR STE A
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7327
Practice Address - Country:US
Practice Address - Phone:215-624-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002953L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA257966300OtherPERSONAL CHOICE
PA01476490Medicaid
PA01476490-01OtherAMERICHOICE
PA257966300OtherKEYSTONE HPE
PA232774684OtherUNITED HEALTHCARE
PA834065OtherAETNA