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NPI Code Detail

MEDICARE: MOSCOW HEALTH AND WELLNESS CENTER, P.L.L.C.

MEDICARE: MOSCOW HEALTH AND WELLNESS CENTER, P.L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorID
2111N00000XChiropractorCHIA-1387ID

General Provider Information

NPI Number : 1134456031
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOSCOW HEALTH AND WELLNESS CENTER, P.L.L.C.
Provider Business Mailing Address
First Line : 317 W 6TH ST STE 206
Second Line :
City : MOSCOW
State : ID
Zip : 83843-2387
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 317 W 6TH ST STE 206
Second Line :
City : MOSCOW
State : ID
Zip : 83843-2387
Country : US
Telephone Number : 310-740-6141
Fax Number :
Authorized Official
Title or Position : DOCTOR OF CHIROPRACTIC
Name : DR. BAILEY LYNN SMITH
Credential : D.C.
Telephone Number : 310-740-6141
Provider Enumeration Date : 11/13/2009
Last Update Date : 11/13/2009

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Directions to “MOSCOW HEALTH AND WELLNESS CENTER, P.L.L.C. ” Practice Location

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