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Individual

MR. DAVID EARL MOSS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
429 N PAW PAW ST, COLOMA, MI 49038-9567
(269) 468-5775
(269) 468-3447
Mailing address
PO BOX 224, COLOMA, MI 49038-0224
(269) 468-5775
(269) 468-3447

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301004790
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12510467
MULTI PLAN
MI
01
4430062
IBA UHC PHP
01
950A111470
BLUE CROSS BLUE SHIELD
MI
01
DM004790
STATE LICENSE NUMBER
MI
Enumeration date
12/07/2005
Last updated
10/16/2018
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