Provider Demographics
NPI:1093855173
Name:MOGER, KENNETH H (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:MOGER
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 1:7508 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3001
Mailing Address - Country:US
Mailing Address - Phone:916-722-5050
Mailing Address - Fax:916-722-0252
Practice Address - Street 1:7508 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-3001
Practice Address - Country:US
Practice Address - Phone:916-722-5050
Practice Address - Fax:916-722-0252
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0230650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU73431Medicare UPIN
CADC0230650Medicare ID - Type Unspecified