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Individual
RANDELL WAYNE MOSS
Active
Individual
RANDELL WAYNE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4692
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350027566
RAIL ROAD MEDICARE
TX
01
—
4361073
AETNA
TX
01
—
8A7230
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/05/2006
Last updated
08/27/2018
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