MEDICARE: SCOTT A MOON D.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
1	111N00000X	Chiropractor	5153	AZ

General Provider Information

NPI Number	:	1801841341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT A MOON D.C.

Provider Business Mailing Address
First Line	:	1751 STOCKTON HILL ROAD
Second Line	:	SUITE B
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6601
Country	:	US
Telephone Number	:	928-753-1120
Fax Number	:	928-753-6191

Provider Business Practice Location Address
First Line	:	1751 N STOCKTON HILL RD
Second Line	:	SUITE B
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6601
Country	:	US
Telephone Number	:	928-753-1120
Fax Number	:	928-753-6191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	05/03/2012

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Directions to “ SCOTT A MOON D.C.” Practice Location

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