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General NPI Number Information
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NPI Number | 1962825588
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Entity Type | Organization
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Legal Business Name | MOSSUTO CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 7540 METROPOLITAN DR SUITE 109
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City | SAN DIEGO
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State | CA
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Zip | 92108-4499
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Country | US
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Telephone | 619-294-9342
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Fax |
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Provider Business Mailing Address
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Address Line | 7540 METROPOLITAN DR SUITE 109
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City | SAN DIEGO
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State | CA
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Zip | 92108-4499
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK MOSSUTO
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Credential | DC
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Telephone | 619-294-9342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC23070
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License Number State | CA
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