Organization
MOSS CHIROPRACTIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARYL A. MOSS I D.C. (PRESIDENT)
(208) 527-3039
Entity
Organization
Contact information
Practice address
1278 S WOODRUFF AVE, IDAHO FALLS, ID 83404-5544
(208) 524-3018
(208) 524-3019
Mailing address
1278 S WOODRUFF AVE, IDAHO FALLS, ID 83404-5544
(208) 524-3018
(208) 524-3019
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-896
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028117
BLUE SHIELD OF IDAHO
ID
05
—
807164600
—
ID
01
—
C1823
BLUE CROSS OF IDAHO
ID
Enumeration date
04/04/2007
Last updated
01/13/2012
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