Provider Demographics
NPI:1124078761
Name:MOSHER, LEON A JR (DC)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:A
Last Name:MOSHER
Suffix:JR
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 1:33 MARSH STREET
Mailing Address - Street 2:
Mailing Address - City:WYALUSING
Mailing Address - State:PA
Mailing Address - Zip Code:18853-0791
Mailing Address - Country:US
Mailing Address - Phone:570-746-0870
Mailing Address - Fax:570-746-0471
Practice Address - Street 1:33 MARSH STREET
Practice Address - Street 2:
Practice Address - City:WYALUSING
Practice Address - State:PA
Practice Address - Zip Code:18853-0791
Practice Address - Country:US
Practice Address - Phone:570-746-0870
Practice Address - Fax:570-746-0471
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004662L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50051972OtherCAPITAL BLUE CROSS
PAM0656553OtherBLUE CROSS BLUE SHIELD
PAM0656553Medicare ID - Type Unspecified