Provider Demographics
NPI:1538307921
Name:MOSHER, DOUGLAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:MOSHER
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:P.O. BOX 705
Mailing Address - Street 2:55 ANGWIN PLAZA
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508
Mailing Address - Country:US
Mailing Address - Phone:707-965-0532
Mailing Address - Fax:707-965-1535
Practice Address - Street 1:55 ANGWIN PLAZA
Practice Address - Street 2:
Practice Address - City:ANGWIN
Practice Address - State:CA
Practice Address - Zip Code:94508
Practice Address - Country:US
Practice Address - Phone:707-965-0532
Practice Address - Fax:707-965-1535
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0177630Medicare PIN