Provider Demographics
NPI:1730377490
Name:MOSES FAMILY CHIROPRACTIC & WELLNESS CENTER, P.C.
Entity type:Organization
Organization Name:MOSES FAMILY CHIROPRACTIC & WELLNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:586-323-5060
Mailing Address - Street 1:PO BOX 183051
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48318-3051
Mailing Address - Country:US
Mailing Address - Phone:586-323-5060
Mailing Address - Fax:586-323-5062
Practice Address - Street 1:45941 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6217
Practice Address - Country:US
Practice Address - Phone:586-323-5060
Practice Address - Fax:586-323-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P50140Medicare PIN