Provider Demographics
NPI:1538406368
Name:MOSER, MELINDA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:MARIE
Last Name:MOSER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:MARIE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1032 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2019
Mailing Address - Country:US
Mailing Address - Phone:218-233-3600
Mailing Address - Fax:
Practice Address - Street 1:1032 CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2019
Practice Address - Country:US
Practice Address - Phone:218-233-3600
Practice Address - Fax:218-233-3077
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor