Provider Demographics
NPI:1841401700
Name:MOSENG, BRUCE ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:MOSENG
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 1:240 JENNIFER LANE
Mailing Address - Street 2:STE 103
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326
Mailing Address - Country:US
Mailing Address - Phone:928-634-0733
Mailing Address - Fax:928-634-0735
Practice Address - Street 1:240 JENNIFER LANE
Practice Address - Street 2:STE 103
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326
Practice Address - Country:US
Practice Address - Phone:928-634-0733
Practice Address - Fax:928-634-0735
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103344Medicare ID - Type Unspecified
AZ103343Medicare ID - Type Unspecified