Provider Demographics
NPI:1871629634
Name:MORA, JOHN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MORA
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:PO BOX 4231
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-1231
Mailing Address - Country:US
Mailing Address - Phone:626-485-7283
Mailing Address - Fax:562-864-2125
Practice Address - Street 1:11460 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3142
Practice Address - Country:US
Practice Address - Phone:626-485-7283
Practice Address - Fax:562-864-2125
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24518Medicare ID - Type Unspecified
CAU64574Medicare UPIN