Provider Demographics
NPI:1205864113
Name:MOSSBURG, PATRICK HENRY (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:HENRY
Last Name:MOSSBURG
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 1:1525 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1593
Mailing Address - Country:US
Mailing Address - Phone:419-633-0550
Mailing Address - Fax:419-633-9399
Practice Address - Street 1:1525 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1593
Practice Address - Country:US
Practice Address - Phone:419-633-0550
Practice Address - Fax:419-633-9399
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2199419Medicaid
OHMO4035311Medicare ID - Type Unspecified
OH2199419Medicaid