Provider Demographics
NPI:1285002196
Name:MOSS ENTERPRISE
Entity type:Organization
Organization Name:MOSS ENTERPRISE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR-PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-542-0780
Mailing Address - Street 1:958 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2148
Mailing Address - Country:US
Mailing Address - Phone:864-542-0780
Mailing Address - Fax:564-542-1689
Practice Address - Street 1:958 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2148
Practice Address - Country:US
Practice Address - Phone:864-542-0780
Practice Address - Fax:564-542-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2834 DC111N00000X
SCMD4473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty