Provider Demographics
NPI:1356586317
Name:MOSS FAMILY CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:MOSS FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-964-9114
Mailing Address - Street 1:1932 SW 3RD ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2400
Mailing Address - Country:US
Mailing Address - Phone:515-964-9114
Mailing Address - Fax:515-964-9117
Practice Address - Street 1:1932 SW 3RD ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2400
Practice Address - Country:US
Practice Address - Phone:515-964-9114
Practice Address - Fax:515-964-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty