Provider Demographics
NPI:1972582898
Name:MOSCATEL, PHILIP PAUL (DC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:PAUL
Last Name:MOSCATEL
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 1:100 WEST ROOSEVELT ROAD
Mailing Address - Street 2:B5 - SUITE 103
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-469-4422
Mailing Address - Fax:
Practice Address - Street 1:100 WEST ROOSEVELT ROAD
Practice Address - Street 2:B5 - SUITE 103
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-469-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL970440Medicare ID - Type Unspecified