Provider Demographics
NPI:1316580343
Name:MOOS FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOOS FAMILY CHIROPRACTIC LLC
Other - Org Name:MOOS FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-285-4653
Mailing Address - Street 1:517 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5702
Mailing Address - Country:US
Mailing Address - Phone:701-258-4653
Mailing Address - Fax:701-258-5410
Practice Address - Street 1:517 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5702
Practice Address - Country:US
Practice Address - Phone:701-258-4653
Practice Address - Fax:701-258-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center