Provider Demographics
NPI:1770551707
Name:MOHR, DAVID GUSTAV (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GUSTAV
Last Name:MOHR
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 1:4031 S CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-8704
Mailing Address - Country:US
Mailing Address - Phone:765-653-4447
Mailing Address - Fax:765-653-6818
Practice Address - Street 1:4031 S CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-8704
Practice Address - Country:US
Practice Address - Phone:765-653-4447
Practice Address - Fax:765-653-6818
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100210890Medicaid
IN85630OtherANTHEM
IN100210890Medicaid
IN681120Medicare PIN