Provider Demographics
NPI:1558584375
Name:MOUL, MICHELE (DC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MOUL
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 1:1331 EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6501
Mailing Address - Country:US
Mailing Address - Phone:309-347-2700
Mailing Address - Fax:
Practice Address - Street 1:1331 EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6501
Practice Address - Country:US
Practice Address - Phone:309-347-0404
Practice Address - Fax:309-347-0407
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
K22821Medicare ID - Type Unspecified