Provider Demographics
NPI:1699954693
Name:DOUGLAS MOSHER DC INC
Entity type:Organization
Organization Name:DOUGLAS MOSHER DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF BUSINESS
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-965-0532
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508
Mailing Address - Country:US
Mailing Address - Phone:707-965-0532
Mailing Address - Fax:707-965-1535
Practice Address - Street 1:55 ANGWIN PLAZA
Practice Address - Street 2:
Practice Address - City:ANGWIN
Practice Address - State:CA
Practice Address - Zip Code:94508
Practice Address - Country:US
Practice Address - Phone:707-965-0532
Practice Address - Fax:707-965-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0177630Medicare PIN