Provider Demographics
NPI:1619074218
Name:MOOS, AARON ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:ROBERT
Last Name:MOOS
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 1:517 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 1:1103 REEVES ROAD W
Practice Address - Street 2:STE A
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-586-5152
Practice Address - Fax:406-586-3547
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT938111N00000X
ND710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0164152Medicaid
MT40073OtherBLUE CROSS BLUE SHIELD