Healthcare Provider Details

I. General information

NPI: 1538925292
Provider Name (Legal Business Name): MOE CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 OHMS LN
EDINA MN
55439-2140
US

IV. Provider business mailing address

7108 OHMS LN
EDINA MN
55439-2140
US

V. Phone/Fax

Practice location:
  • Phone: 952-833-3038
  • Fax: 952-833-3040
Mailing address:
  • Phone: 952-833-3038
  • Fax: 952-833-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS C MOE
Title or Position: CEO
Credential: DC
Phone: 952-833-3038