Provider Demographics
NPI:1205807682
Name:MOSES, ANDREA B (DC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
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 1:3105 LIMESTONE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2147
Mailing Address - Country:US
Mailing Address - Phone:302-993-9113
Mailing Address - Fax:302-993-0313
Practice Address - Street 1:3105 LIMESTONE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2147
Practice Address - Country:US
Practice Address - Phone:302-993-9113
Practice Address - Fax:302-993-0313
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE522088872OtherBCBS
DE1040507OtherAETNA
DE901494Medicare ID - Type Unspecified