Provider Demographics
NPI:1275734196
Name:AMSO, BASHAR (DC)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:AMSO
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 1:310 MILITARY W
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3078
Mailing Address - Country:US
Mailing Address - Phone:707-642-2676
Mailing Address - Fax:
Practice Address - Street 1:310 MILITARY W
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3078
Practice Address - Country:US
Practice Address - Phone:707-642-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0273830Medicare ID - Type UnspecifiedMEDICARE ID