Provider Demographics
NPI:1750123261
Name:MOUSA, RANY (DC)
Entity type:Individual
Prefix:DR
First Name:RANY
Middle Name:
Last Name:MOUSA
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 1:26400 LAHSER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2672
Mailing Address - Country:US
Mailing Address - Phone:917-449-7582
Mailing Address - Fax:727-821-8913
Practice Address - Street 1:26400 LAHSER RD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2672
Practice Address - Country:US
Practice Address - Phone:917-449-7582
Practice Address - Fax:727-821-8913
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor