Provider Demographics
NPI:1790886984
Name:MOBLEY, AARON M (DC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:MOBLEY
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 1:3901 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5538
Mailing Address - Country:US
Mailing Address - Phone:812-334-0082
Mailing Address - Fax:812-334-1019
Practice Address - Street 1:3901 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5538
Practice Address - Country:US
Practice Address - Phone:812-334-0082
Practice Address - Fax:812-334-1019
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002294A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200843530AMedicaid
IN200843530AMedicaid