MEDICARE: MAEGAN MOSELEY STANGA D.C.

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	11761	TX

General Provider Information

NPI Number	:	1396030219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAEGAN MOSELEY STANGA D.C.

Provider Business Mailing Address
First Line	:	28770 BERMUDA BAY WAY
Second Line	:	#204
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-1305
Country	:	US
Telephone Number	:	214-714-1161
Fax Number	:

Provider Business Practice Location Address
First Line	:	17219 OCONNOR RD
Second Line	:	STE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5678
Country	:	US
Telephone Number	:	972-345-0206
Fax Number	:

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	02/02/2016

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