Provider Demographics
NPI:1376661470
Name:MOSELLE CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:MOSELLE CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-615-0056
Mailing Address - Street 1:5 SAGAMORE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3115
Mailing Address - Country:US
Mailing Address - Phone:518-615-0056
Mailing Address - Fax:518-615-0059
Practice Address - Street 1:5 SAGAMORE ST
Practice Address - Street 2:SUITE B
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3115
Practice Address - Country:US
Practice Address - Phone:518-615-0056
Practice Address - Fax:518-615-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002086-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26485Medicare UPIN
NYAA0093Medicare ID - Type Unspecified