Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 15474 | CA |
NPI | 1003832338 |
---|---|
Provider Name | Dr. John M Mooney |
First Address | Placerville, CA 95667-9001 |
Second Address | Placerville, CA 95667-9001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 31/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GDC000640 | (05) | CA |
T05778 | (02) | CA |