Provider Demographics
NPI:1023283777
Name:MOUSEL, FRED L (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:L
Last Name:MOUSEL
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 1:207 10TH ST
Mailing Address - Street 2:PO BOX 381
Mailing Address - City:ALTON
Mailing Address - State:IA
Mailing Address - Zip Code:51003-0381
Mailing Address - Country:US
Mailing Address - Phone:712-756-8989
Mailing Address - Fax:
Practice Address - Street 1:207 10TH ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IA
Practice Address - Zip Code:51003-0381
Practice Address - Country:US
Practice Address - Phone:712-756-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27111Medicare UPIN