Provider Demographics
NPI:1902807373
Name:MOSS, MICHAEL B (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:MOSS
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 1:1377 DELTONA BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4412
Mailing Address - Country:US
Mailing Address - Phone:352-683-7886
Mailing Address - Fax:352-683-4799
Practice Address - Street 1:377 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-683-7886
Practice Address - Fax:352-683-4799
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51785Medicare UPIN
FL55189AMedicare ID - Type Unspecified
FL55189ZMedicare PIN