Healthcare Provider Details

I. General information

NPI: 1366091860
Provider Name (Legal Business Name): MOSES CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 8TH ST NE
WASHINGTON DC
20002-5228
US

IV. Provider business mailing address

400 8TH ST NE
WASHINGTON DC
20002-5228
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOSES OGBEMUDIA
Title or Position: PROVIDER
Credential:
Phone: 202-546-2000