Provider Demographics
NPI:1417267709
Name:MOSSELL HOLISTIC HEALTH CARE LLC
Entity Type:Organization
Organization Name:MOSSELL HOLISTIC HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MOSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-412-4083
Mailing Address - Street 1:1420 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 411
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1310
Mailing Address - Country:US
Mailing Address - Phone:847-296-0505
Mailing Address - Fax:847-768-9630
Practice Address - Street 1:1420 N NORTHWEST HWY
Practice Address - Street 2:SUITE 411
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1310
Practice Address - Country:US
Practice Address - Phone:847-296-0505
Practice Address - Fax:847-768-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184737199Medicare UPIN