Provider Demographics
NPI:1689870099
Name:MOSLEY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MOSLEY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:563-343-3920
Mailing Address - Street 1:4829 W MAIN ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4700
Mailing Address - Country:US
Mailing Address - Phone:618-355-9510
Mailing Address - Fax:
Practice Address - Street 1:4829 W MAIN ST
Practice Address - Street 2:UNIT A
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-4700
Practice Address - Country:US
Practice Address - Phone:618-355-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty