Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2301008246 | MI |
NPI | 1134276447 |
---|---|
Provider Name | Dr. John Mousa Mufarreh |
First Address | Dearborn, MI 48124-1071 |
Second Address | Dearborn, MI 48121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |