Provider Demographics
NPI:1609887918
Name:MOEGLING, MARTHA ANN (DC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:MOEGLING
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:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60145-0240
Mailing Address - Country:US
Mailing Address - Phone:815-784-4554
Mailing Address - Fax:815-784-4747
Practice Address - Street 1:112 N EMMETT ST STE A
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1087
Practice Address - Country:US
Practice Address - Phone:815-784-4554
Practice Address - Fax:815-784-4747
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17570Medicare ID - Type Unspecified
ILU82999Medicare UPIN