Provider Demographics
NPI:1558583328
Name:MOGER GANCAS CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:MOGER GANCAS CHIROPRACTIC CORPORATION
Other - Org Name:RIVER CITY CHIORPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:MOGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-722-5050
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0230050111N00000X
CADC0230650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty