Provider Demographics
NPI:1073222147
Name:MOSLOW, KYLE JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:MOSLOW
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 1:15425 N GREENWAY HAYDEN LOOP STE A200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1239
Mailing Address - Country:US
Mailing Address - Phone:480-443-7678
Mailing Address - Fax:480-443-7661
Practice Address - Street 1:15425 N GREENWAY HAYDEN LOOP STE A200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1239
Practice Address - Country:US
Practice Address - Phone:480-443-7678
Practice Address - Fax:480-443-7661
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor