Individual
DERRYL E MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
110 MAIN STREET, FAIRMOUNT, ND 58030-0291
(701) 474-5948
Mailing address
PO BOX 291, FAIRMOUNT, ND 58030-0291
(701) 474-5948
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
342
ND
Other
Enumeration date
08/15/2006
Last updated
12/12/2007
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