Provider Demographics
NPI:1194071555
Name:MOSLEY, MIRIAM ANNA (DC)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ANNA
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 GREENWOOD AVE N
Mailing Address - Street 2:UNIT 103
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7054
Mailing Address - Country:US
Mailing Address - Phone:206-678-3851
Mailing Address - Fax:
Practice Address - Street 1:753 N 35TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8870
Practice Address - Country:US
Practice Address - Phone:206-678-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60284738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor