Provider Demographics
NPI:1386761880
Name:MOON, STEVEN L (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:MOON
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 1:5161 CLAYTON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3191
Mailing Address - Country:US
Mailing Address - Phone:925-682-8400
Mailing Address - Fax:
Practice Address - Street 1:5161 CLAYTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3191
Practice Address - Country:US
Practice Address - Phone:925-682-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC-0153230OtherBLUE CROSS BLUE SHIELD