Provider Demographics
NPI:1083678478
Name:MOES, ADAM (LAC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:MOES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 MANZANITA AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1369
Mailing Address - Country:US
Mailing Address - Phone:530-828-2589
Mailing Address - Fax:866-213-4679
Practice Address - Street 1:574 MANZANITA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1369
Practice Address - Country:US
Practice Address - Phone:530-828-2589
Practice Address - Fax:866-213-4679
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8607247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other