Provider Demographics
NPI:1912907999
Name:MOSCHILLO, DANIEL JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JACK
Last Name:MOSCHILLO
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 1:192 N BUHL FARM DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1773
Mailing Address - Country:US
Mailing Address - Phone:724-347-5125
Mailing Address - Fax:724-347-5140
Practice Address - Street 1:192 N BUHL FARM DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-1773
Practice Address - Country:US
Practice Address - Phone:724-347-5125
Practice Address - Fax:724-923-3015
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001469951OtherMEDICAL MUTUAL OF OHIO
PA001469238OtherPA BLUE CROSS/BLUE SHIELD
PA001469951OtherHIGHMARK BLUE SHIELD
PA522375090OtherHEALTH ASSURANCE
PA52-2375090OtherPA WORK COMP
PA1041072OtherCIGNA/HEALTH AMERICA
PA001953053Medicaid
PA0019530530001Medicaid
PA3551313OtherAETNA
PA3551313OtherAETNA
PAU94533Medicare UPIN