Organization
MOSS CHIROPRACTIC CLINIC P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PENNY L MOSS (OFFICE MGR/OWNER)
(269) 468-5775
Entity
Organization
Contact information
Practice address
429 N. PAW PAW STREET, COLOMA, MI 49038
(269) 468-5775
(269) 468-3447
Mailing address
POB 224, COLOMA, MI 49038
(269) 468-5775
(269) 468-3447
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
950A111480
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
01/11/2008
Last updated
11/01/2018
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