MEDICARE: JOSEPH MOEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1283	SD

General Provider Information

NPI Number	:	1972969293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MOEN

Provider Business Mailing Address
First Line	:	5800 E 18TH ST
Second Line	:	STE 102
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-2711
Country	:	US
Telephone Number	:	307-286-2994
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 E 18TH ST
Second Line	:	STE 102
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-2711
Country	:	US
Telephone Number	:	605-371-3533
Fax Number	:	605-371-1781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	08/22/2019

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Directions to “ JOSEPH MOEN ” Practice Location

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