Provider Demographics
NPI:1184783300
Name:MOSS, DAMON THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:THOMAS
Last Name:MOSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAMON
Other - Middle Name:THOMAS
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4361 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6253
Mailing Address - Country:US
Mailing Address - Phone:561-627-7771
Mailing Address - Fax:561-627-5948
Practice Address - Street 1:4361 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6253
Practice Address - Country:US
Practice Address - Phone:561-627-7771
Practice Address - Fax:561-627-5948
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5950Medicare ID - Type Unspecified