Provider Demographics
NPI:1184737199
Name:MOSSELL, DANIEL KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KEITH
Last Name:MOSSELL
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 1:7140 N MCALPIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-1220
Mailing Address - Country:US
Mailing Address - Phone:773-631-3840
Mailing Address - Fax:773-631-5908
Practice Address - Street 1:1 S NORTHWEST HWY STE B2
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4240
Practice Address - Country:US
Practice Address - Phone:847-768-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
412027646OtherFEIN
IL472-250Medicare ID - Type Unspecified