Provider Demographics
NPI:1679634547
Name:MOSELEY, MICHELE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LYNN
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:CRISWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6010 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7826
Mailing Address - Country:US
Mailing Address - Phone:570-966-6866
Mailing Address - Fax:
Practice Address - Street 1:6010 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7826
Practice Address - Country:US
Practice Address - Phone:570-966-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007904L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor