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General NPI Number Information
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NPI Number | 1871851329
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Entity Type | Organization
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Legal Business Name | MOUA-LOR CHIROPRACTIC AND ACUPUNCTURE, PA
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 5600 BASS LAKE RD STE D
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City | CRYSTAL
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State | MN
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Zip | 55429-2722
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Country | US
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Telephone | 612-529-0202
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Fax | 612-521-1445
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Provider Business Mailing Address
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Address Line | 5600 BASS LAKE RD STE D
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City | CRYSTAL
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State | MN
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Zip | 55429-2722
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Country | US
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Telephone | 612-529-0202
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Fax | 612-521-1445
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. YER MOUA-LOR
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Credential | D.C.
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Telephone | 612-529-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4013
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License Number State | MN
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