Provider Demographics
NPI:1396927901
Name:JEVICKY, MOSES MICAH (DC,)
Entity type:Individual
Prefix:DR
First Name:MOSES
Middle Name:MICAH
Last Name:JEVICKY
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 1:590 INDIAN SPRINGS RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3600
Mailing Address - Country:US
Mailing Address - Phone:724-465-2230
Mailing Address - Fax:724-465-2235
Practice Address - Street 1:590 INDIAN SPRINGS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3600
Practice Address - Country:US
Practice Address - Phone:724-465-2230
Practice Address - Fax:724-465-2235
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009879111N00000X
PAAJ009695111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation