Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC27267 | CA |
N | 111NI0013X | Independent Medical Examiner | DC27267 | CA |
NPI | 1720385230 |
---|---|
Provider Name | Dr. Kerry A Moses |
First Address | Berkeley, CA 94702-2565 |
Second Address | Berkeley, CA 94702-2565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2011 |
Last Update Date | 17/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0272670 | (02) | CA |