Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2216 | TN |
NPI | 1093888976 |
---|---|
Provider Name | Dr. Randy C Moze |
First Address | Johnson City, TN 37602-3563 |
Second Address | Johnson City, TN 37604-4903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 06/12/2011 |