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General NPI Number Information
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NPI Number | 1669140968
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Entity Type | Individual
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Provider Name | CHIA MOUA DC
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Gender | Male
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 926 WILLARD DR STE 218
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City | ASHWAUBENON
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State | WI
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Zip | 54304-5071
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Country | US
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Telephone | 920-316-1103
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 PILGRIM WAY APT C
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City | ASHWAUBENON
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State | WI
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Zip | 54304-5833
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Country | US
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Telephone | 920-254-0227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5626-12
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License Number State | WI
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