Healthcare Provider Details

I. General information

NPI: 1417558438
Provider Name (Legal Business Name): ELLIOTT MOSES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 N 6TH ST
INDIANOLA IA
50125-4873
US

IV. Provider business mailing address

425 W MISSION ST
STRAWBERRY POINT IA
52076-9435
US

V. Phone/Fax

Practice location:
  • Phone: 515-961-5202
  • Fax:
Mailing address:
  • Phone: 563-608-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number106179
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: