Provider Demographics
NPI:1013450584
Name:MOUROUX FAMILY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MOUROUX FAMILY CHIROPRACTIC INC.
Other - Org Name:MOUROUX CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MOUROUX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-379-8888
Mailing Address - Street 1:1888 SARATOGA AVE
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5214
Mailing Address - Country:US
Mailing Address - Phone:408-379-8888
Mailing Address - Fax:408-379-8833
Practice Address - Street 1:1888 SARATOGA AVE
Practice Address - Street 2:SUITE # 101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5214
Practice Address - Country:US
Practice Address - Phone:408-379-8888
Practice Address - Fax:408-379-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty