Provider Demographics
NPI:1891075040
Name:MULDOON, JAMES ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROSS
Last Name:MULDOON
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 1:29680 S WIXOM RD
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-3430
Mailing Address - Country:US
Mailing Address - Phone:248-892-7246
Mailing Address - Fax:248-869-6000
Practice Address - Street 1:29680 S WIXOM RD
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3430
Practice Address - Country:US
Practice Address - Phone:248-892-7246
Practice Address - Fax:248-869-6000
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1992207111NN0400X
MI2301009804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1125003Medicare PIN