Provider Demographics
NPI:1164597779
Name:MOSS, PAUL R (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:MOSS
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 1:1932 SW 3RD ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2400
Mailing Address - Country:US
Mailing Address - Phone:515-964-9114
Mailing Address - Fax:
Practice Address - Street 1:1932 SW 3RD ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2400
Practice Address - Country:US
Practice Address - Phone:515-964-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor