Provider Demographics
NPI:1962647404
Name:JOSHUA B. MOSKAL DC, PLLC
Entity Type:Organization
Organization Name:JOSHUA B. MOSKAL DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:MOSKAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-787-6660
Mailing Address - Street 1:609 N WISNER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3139
Mailing Address - Country:US
Mailing Address - Phone:517-787-6660
Mailing Address - Fax:517-787-9743
Practice Address - Street 1:609 N WISNER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3139
Practice Address - Country:US
Practice Address - Phone:517-787-6660
Practice Address - Fax:517-787-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty