Provider Demographics
NPI:1104855691
Name:MOORHOUSE, MICHAEL JOSHUA (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSHUA
Last Name:MOORHOUSE
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 1:4660 N PENNGROVE WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-8042
Mailing Address - Country:US
Mailing Address - Phone:208-938-2992
Mailing Address - Fax:208-938-3476
Practice Address - Street 1:4660 N PENNGROVE WAY STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-8042
Practice Address - Country:US
Practice Address - Phone:208-938-2992
Practice Address - Fax:208-938-3476
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00010149230OtherBLUE SHEILD
IDC4389OtherBLUE CROSS
ID00010149230OtherBLUE SHEILD
ID1675612Medicare ID - Type Unspecified