Provider Demographics
NPI:1457536237
Name:MOSCOW CHIROPRACTIC LLC.
Entity Type:Organization
Organization Name:MOSCOW CHIROPRACTIC LLC.
Other - Org Name:DR. MOSCOW & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:CHENG
Authorized Official - Last Name:MOSCOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-954-3700
Mailing Address - Street 1:1071 S TUTTLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-8107
Mailing Address - Country:US
Mailing Address - Phone:941-954-3700
Mailing Address - Fax:941-296-8202
Practice Address - Street 1:1071 S TUTTLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-8107
Practice Address - Country:US
Practice Address - Phone:941-954-3700
Practice Address - Fax:941-296-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381875600Medicaid
FL89873ZMedicare PIN
FLV03933Medicare UPIN