Provider Demographics
NPI:1528084944
Name:ROBERT S. DEMOSS, A CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:ROBERT S. DEMOSS, A CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:DEMOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:949-492-5511
Mailing Address - Street 1:131 W EL PORTAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4633
Mailing Address - Country:US
Mailing Address - Phone:949-492-5511
Mailing Address - Fax:949-325-0036
Practice Address - Street 1:131 W EL PORTAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4633
Practice Address - Country:US
Practice Address - Phone:949-492-5511
Practice Address - Fax:949-325-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88268Medicare UPIN