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General NPI Number Information
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NPI Number | 1134456031
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Entity Type | Organization
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Legal Business Name | MOSCOW HEALTH AND WELLNESS CENTER, P.L.L.C.
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 317 W 6TH ST STE 206
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City | MOSCOW
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State | ID
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Zip | 83843-2387
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Country | US
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Telephone | 310-740-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 317 W 6TH ST STE 206
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City | MOSCOW
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State | ID
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Zip | 83843-2387
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. BAILEY LYNN SMITH
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Credential | D.C.
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Telephone | 310-740-6141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-1387
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License Number State | ID
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