Provider Demographics
NPI:1528598794
Name:MOSER, BRIAN GERALD (ORGANIZATION OWNER)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:GERALD
Last Name:MOSER
Suffix:
Gender:M
Credentials:ORGANIZATION OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N 3025 W
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015-3258
Mailing Address - Country:US
Mailing Address - Phone:801-499-6535
Mailing Address - Fax:
Practice Address - Street 1:761 W ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1630
Practice Address - Country:US
Practice Address - Phone:801-779-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor