MEDICARE: DR. MOLLY SANDEEP MOSCHOVAS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038013158	IL

General Provider Information

NPI Number	:	1740790385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY SANDEEP MOSCHOVAS DC

Provider Business Mailing Address
First Line	:	1706 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2125
Country	:	US
Telephone Number	:	773-697-8088
Fax Number	:	888-404-8086

Provider Business Practice Location Address
First Line	:	1706 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2125
Country	:	US
Telephone Number	:	773-697-8088
Fax Number	:	888-404-8086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	11/13/2019

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Directions to “ DR. MOLLY SANDEEP MOSCHOVAS DC” Practice Location

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