Provider Demographics
NPI:1902024557
Name:MOSHER CHIROPRACTIC PA
Entity Type:Organization
Organization Name:MOSHER CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-864-1701
Mailing Address - Street 1:6205 DR MLK JR ST SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705
Mailing Address - Country:US
Mailing Address - Phone:727-864-1701
Mailing Address - Fax:727-866-6178
Practice Address - Street 1:6205 DR MLK JR ST SOUTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705
Practice Address - Country:US
Practice Address - Phone:727-864-1701
Practice Address - Fax:727-866-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007079111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55406AMedicaid
FL55406AMedicare ID - Type Unspecified
FL55406AMedicaid