Provider Demographics
NPI:1417558438
Name:MOSES, ELLIOTT (DC)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:MOSES
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 1:425 W MISSION ST
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52076-9435
Mailing Address - Country:US
Mailing Address - Phone:563-608-2554
Mailing Address - Fax:
Practice Address - Street 1:2007 N 6TH ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-4873
Practice Address - Country:US
Practice Address - Phone:515-961-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor