Provider Demographics
NPI:1396030219
Name:STANGA, MAEGAN MOSELEY (DC)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:MOSELEY
Last Name:STANGA
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 1:28770 BERMUDA BAY WAY
Mailing Address - Street 2:#204
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1305
Mailing Address - Country:US
Mailing Address - Phone:214-714-1161
Mailing Address - Fax:
Practice Address - Street 1:17219 OCONNOR RD
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5678
Practice Address - Country:US
Practice Address - Phone:972-345-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX469142ZNSCMedicare PIN