Provider Demographics
NPI:1669541900
Name:MOSES, LARRY (DC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MOSES
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 1:8114 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-1815
Mailing Address - Country:US
Mailing Address - Phone:215-333-2688
Mailing Address - Fax:
Practice Address - Street 1:4024 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19135-1608
Practice Address - Country:US
Practice Address - Phone:215-333-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002678L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor