Provider Demographics
NPI:1235781147
Name:MOSELEY, EVELYN (DC)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
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:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-0878
Mailing Address - Country:US
Mailing Address - Phone:650-392-4054
Mailing Address - Fax:
Practice Address - Street 1:30 PORTOLA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL GRANADA
Practice Address - State:CA
Practice Address - Zip Code:94018
Practice Address - Country:US
Practice Address - Phone:650-440-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor