Basic Information
| Provider Information | |||||||||
| NPI: | 1689870099 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOSLEY CHIROPRACTIC, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4829 W MAIN ST | ||||||||
| Address2: | UNIT A | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622264700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183559510 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4829 W MAIN ST | ||||||||
| Address2: | UNIT A | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622264700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183559510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOSLEY | ||||||||
| AuthorizedOfficialFirstName: | DANNY | ||||||||
| AuthorizedOfficialMiddleName: | TRENT | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5633433920 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.