Provider Demographics
NPI:1508138041
Name:MOZINGO, TRENT D (DC)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:D
Last Name:MOZINGO
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 1:1899 N COUNTY ROAD 950 W
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:IN
Mailing Address - Zip Code:47023-8483
Mailing Address - Country:US
Mailing Address - Phone:812-569-5685
Mailing Address - Fax:
Practice Address - Street 1:3780 W JONATHAN MOORE PIKE STE 160
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-9430
Practice Address - Country:US
Practice Address - Phone:812-569-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002618A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor