Provider Demographics
NPI:1255458436
Name:DEMOSS, MATTHEW JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:DEMOSS
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 1:1421 N WANDA RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5343
Mailing Address - Country:US
Mailing Address - Phone:714-532-0999
Mailing Address - Fax:714-532-0913
Practice Address - Street 1:1421 N WANDA RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5343
Practice Address - Country:US
Practice Address - Phone:714-532-0999
Practice Address - Fax:714-532-0913
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25316Medicare ID - Type UnspecifiedPROVIDER ID