Provider Demographics
NPI:1740505395
Name:MOSS CHIROPRACTIC & NUTRITION INC
Entity type:Organization
Organization Name:MOSS CHIROPRACTIC & NUTRITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-722-1955
Mailing Address - Street 1:1617 WESTCLIFF DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5524
Mailing Address - Country:US
Mailing Address - Phone:949-722-1955
Mailing Address - Fax:949-722-9555
Practice Address - Street 1:1617 WESTCLIFF DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5524
Practice Address - Country:US
Practice Address - Phone:949-722-1955
Practice Address - Fax:949-722-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU63403Medicare UPIN