Provider Demographics
NPI:1306891858
Name:MOSS, DANIEL R (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:MOSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 CUMMING HWY
Mailing Address - Street 2:STE 304
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8016 CUMMING HWY
Practice Address - Street 2:STE 304
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9350
Practice Address - Country:US
Practice Address - Phone:770-345-9355
Practice Address - Fax:770-345-4290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV06049Medicare UPIN
GA35ZCJHFMedicare ID - Type Unspecified