Provider Demographics
NPI:1043682271
Name:MOAZAMI, MOHSEN (DC)
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:MOAZAMI
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 1:4180 TREAT BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1848
Mailing Address - Country:US
Mailing Address - Phone:661-233-1384
Mailing Address - Fax:
Practice Address - Street 1:4180 TREAT BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1848
Practice Address - Country:US
Practice Address - Phone:661-233-1384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32092111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health