Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | IL |
NPI | 1003011008 |
---|---|
Provider Name | Dr. Danny Trent Mosley II |
First Address | Belleville, IL 62223-3159 |
Second Address | Belleville, IL 62226-4700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 08/07/2007 |