Provider Demographics
NPI:1760984538
Name:CONCORD CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CONCORD CHIROPRACTIC, INC.
Other - Org Name:CONCORD CHIROPRACTIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-682-8400
Mailing Address - Street 1:5167 CLAYTON RD STE A2
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5167 CLAYTON RD STE A2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3100
Practice Address - Country:US
Practice Address - Phone:925-682-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty