Provider Demographics
NPI:1881616142
Name:MOSES, GREGG F (DC)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:F
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 1:1800 FOREST HILL BLVD
Mailing Address - Street 2:SUITE A8-10
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6094
Mailing Address - Country:US
Mailing Address - Phone:561-641-9211
Mailing Address - Fax:561-641-2188
Practice Address - Street 1:1800 FOREST HILL BLVD
Practice Address - Street 2:SUITE A8-10
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6094
Practice Address - Country:US
Practice Address - Phone:561-641-9211
Practice Address - Fax:561-641-2188
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00005949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22321ZOtherMEDICARE INDIVIDUAL PTAN
FL1336403989OtherGROUP NPI
FLGF490AOtherMEDICARE GROUP PTAN
FL650760094OtherTAX ID NO.
FL1881616142OtherINDIVIDUAL NPI
FL22321ZOtherMEDICARE INDIVIDUAL PTAN
FL650760094OtherTAX ID NO.