Provider Demographics
NPI:1649481961
Name:MOOS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:MOOS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-586-5152
Mailing Address - Street 1:1103 REEVES RD
Mailing Address - Street 2:STE. A
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7703
Mailing Address - Country:US
Mailing Address - Phone:406-586-5152
Mailing Address - Fax:406-586-3547
Practice Address - Street 1:1103 REEVES RD
Practice Address - Street 2:STE. A
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7703
Practice Address - Country:US
Practice Address - Phone:406-586-5152
Practice Address - Fax:406-586-3547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT40073OtherBLUE CROSS BLUE SHIELD
MT0164152Medicaid