NPIMap

Organization Active NPI

Moffitt Chiropractic Inc

  • Chiropractor
  • Indio, CA
National Provider Identifier
1629297221
Registry record updated Aug 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC29077 Issued in CA
Legal business name
MOFFITT CHIROPRACTIC INC
Practice address
80150 US Highway 111
Suite C5
Indio, CA 92201-8359
Phone
(760) 863-0435
Fax
(760) 863-0436
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeremy William Moffitt, DCNPI 1942362728
Title
President
Phone
(760) 863-0435

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DC29077 CA Primary

Addresses

Primary practice location

80150 US Highway 111
Suite C5
Indio, CA 92201-8359

Mailing address

80150 US Highway 111
Ste C5
Indio, CA 92201-8359
Phone (760) 863-0435

Other names 1

  • Gonstead Family Chiropractic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100812000835 CA Part B Supplier - Clinic/Group Practice 7911031935 Receives reassigned benefits from 3 practitioners
Practice locations: Indio, CA

National Provider Directory

National Provider Directory

Locations

80150 US Highway 111
Ste C5
Indio, CA 92201
Phone (760) 863-0435

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1629297221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80150 US HIGHWAY 111",
            "address_2": "STE C5",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922018359",
            "telephone_number": "760-863-0435",
            "fax_number": "760-863-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80150 US HIGHWAY 111",
            "address_2": "SUITE C5",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922018359",
            "telephone_number": "760-863-0435",
            "fax_number": "760-863-0436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOFFITT CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "MOFFITT",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-863-0435",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC29077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gonstead Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indio, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.