Provider Demographics
NPI:1619329265
Name:MOUSAVI, ALI (DC)
Entity type:Individual
Prefix:MR
First Name:ALI
Middle Name:
Last Name:MOUSAVI
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 1:1000 S. EASTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095
Mailing Address - Country:US
Mailing Address - Phone:610-532-0657
Mailing Address - Fax:610-532-4258
Practice Address - Street 1:1000 S. EASTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095
Practice Address - Country:US
Practice Address - Phone:610-532-0657
Practice Address - Fax:610-532-4258
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor