Provider Demographics
NPI:1487633178
Name:MOUW, MARK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:MOUW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 POWER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-7734
Mailing Address - Country:US
Mailing Address - Phone:712-366-1611
Mailing Address - Fax:712-366-0722
Practice Address - Street 1:20 POWER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7734
Practice Address - Country:US
Practice Address - Phone:712-366-1611
Practice Address - Fax:712-366-0722
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025239400Medicaid
IA1270090Medicaid
IA1270090Medicaid