Provider Demographics
NPI:1871123950
Name:MOISE-BIRCH, DIEUDONNE ANTOINE (DC)
Entity type:Individual
Prefix:DR
First Name:DIEUDONNE
Middle Name:ANTOINE
Last Name:MOISE-BIRCH
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 1:2505 KACHINA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1573
Mailing Address - Country:US
Mailing Address - Phone:719-544-2009
Mailing Address - Fax:
Practice Address - Street 1:1356 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3314
Practice Address - Country:US
Practice Address - Phone:719-574-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06022111N00000X
COCHR.0008245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor