Provider Demographics
NPI:1578593208
Name:MOON, JEFFREY DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEAN
Last Name:MOON
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 1:888 HINCKLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1503
Mailing Address - Country:US
Mailing Address - Phone:650-344-3495
Mailing Address - Fax:650-777-9144
Practice Address - Street 1:888 HINCKLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1503
Practice Address - Country:US
Practice Address - Phone:650-344-3495
Practice Address - Fax:650-777-9144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-26450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor