MEDICARE: DR. STEVEN L MOON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15323	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC-0153230	OTHER	CA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1386761880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN L MOON D.C.

Provider Business Mailing Address
First Line	:	5161 CLAYTON RD
Second Line	:	SUITE E
City	:	CONCORD
State	:	CA
Zip	:	94521-3191
Country	:	US
Telephone Number	:	925-682-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5161 CLAYTON RD
Second Line	:	SUITE E
City	:	CONCORD
State	:	CA
Zip	:	94521-3191
Country	:	US
Telephone Number	:	925-682-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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