Provider Demographics
NPI:1396807954
Name:MORI, ROBERT MINORU (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MINORU
Last Name:MORI
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 1:18922 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7306
Mailing Address - Country:US
Mailing Address - Phone:714-378-4893
Mailing Address - Fax:714-378-4895
Practice Address - Street 1:18922 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7306
Practice Address - Country:US
Practice Address - Phone:714-378-4893
Practice Address - Fax:714-378-4895
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22414Medicare ID - Type Unspecified
CAU51370Medicare UPIN