Provider Demographics
NPI:1891716320
Name:MORITZ, WILLIAM WYLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WYLIE
Last Name:MORITZ
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 1:915 HILBY AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5359
Mailing Address - Country:US
Mailing Address - Phone:831-394-7555
Mailing Address - Fax:831-394-7282
Practice Address - Street 1:915 HILBY AVE STE 22
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5359
Practice Address - Country:US
Practice Address - Phone:831-394-7555
Practice Address - Fax:831-394-7282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0278230Medicare ID - Type Unspecified