Provider Demographics
NPI:1720370703
Name:MOOS, NOAH JACOB (DC)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:JACOB
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 1:1715 E 6TH ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2771
Mailing Address - Country:US
Mailing Address - Phone:512-524-5292
Mailing Address - Fax:
Practice Address - Street 1:1715 E 6TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2771
Practice Address - Country:US
Practice Address - Phone:512-524-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor