Provider Demographics
NPI:1427140680
Name:MOSSMAN, CHARLES E (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:MOSSMAN
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 1:1408 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1819
Mailing Address - Country:US
Mailing Address - Phone:785-234-0521
Mailing Address - Fax:785-234-2405
Practice Address - Street 1:1408 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1819
Practice Address - Country:US
Practice Address - Phone:785-234-0521
Practice Address - Fax:785-234-2405
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T43801Medicare UPIN
060471Medicare ID - Type Unspecified