Provider Demographics
NPI:1740790385
Name:MOSCHOVAS, MOLLY SANDEEP (DC)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:SANDEEP
Last Name:MOSCHOVAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2125
Mailing Address - Country:US
Mailing Address - Phone:773-697-8088
Mailing Address - Fax:888-404-8086
Practice Address - Street 1:1706 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2125
Practice Address - Country:US
Practice Address - Phone:773-697-8088
Practice Address - Fax:888-404-8086
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor