Provider Demographics
NPI:1134276447
Name:MUFARREH, JOHN MOUSA (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MOUSA
Last Name:MUFARREH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 TANNAHILL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1071
Mailing Address - Country:US
Mailing Address - Phone:313-240-7950
Mailing Address - Fax:
Practice Address - Street 1:18551 W. WARREN
Practice Address - Street 2:STE-200
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48121
Practice Address - Country:US
Practice Address - Phone:313-240-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008246111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION23760Medicare ID - Type Unspecified