Provider Demographics
NPI:1477534287
Name:MOSELLE, BRUCE M (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:MOSELLE
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 1:5 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 1:17 CRONIN RD
Practice Address - Street 2:STE C
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1418
Practice Address - Country:US
Practice Address - Phone:518-615-0056
Practice Address - Fax:518-615-0059
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0020861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T26485Medicare UPIN
NYBB1882Medicare ID - Type Unspecified