MEDICARE: DR. MATTHEW JOHN DEMOSS 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	DC25316	CA

General Provider Information

NPI Number	:	1255458436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JOHN DEMOSS D.C.

Provider Business Mailing Address
First Line	:	1421 N WANDA RD
Second Line	:	SUITE 160
City	:	ORANGE
State	:	CA
Zip	:	92867-5343
Country	:	US
Telephone Number	:	714-532-0999
Fax Number	:	714-532-0913

Provider Business Practice Location Address
First Line	:	1421 N WANDA RD
Second Line	:	SUITE 160
City	:	ORANGE
State	:	CA
Zip	:	92867-5343
Country	:	US
Telephone Number	:	714-532-0999
Fax Number	:	714-532-0913

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	06/30/2014

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