Provider Demographics
NPI:1528181682
Name:MOSES, GREGORY RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RICHARD
Last Name:MOSES
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 1:16222 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1809
Mailing Address - Country:US
Mailing Address - Phone:562-592-1331
Mailing Address - Fax:562-592-4162
Practice Address - Street 1:16222 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1809
Practice Address - Country:US
Practice Address - Phone:562-592-1331
Practice Address - Fax:562-592-4162
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18554Medicare ID - Type Unspecified