Provider Demographics
NPI:1427399021
Name:MOE, NICHOLAS CLAYTON (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CLAYTON
Last Name:MOE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 OHMS LN
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2140
Mailing Address - Country:US
Mailing Address - Phone:952-833-3038
Mailing Address - Fax:952-833-3040
Practice Address - Street 1:7108 OHMS LN
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2140
Practice Address - Country:US
Practice Address - Phone:952-833-3038
Practice Address - Fax:952-833-3040
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5742111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor