Provider Demographics
NPI:1629757422
Name:MOELLER, EVAN (DC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:MOELLER
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 1:515 7TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2132
Mailing Address - Country:US
Mailing Address - Phone:319-366-2225
Mailing Address - Fax:319-366-1726
Practice Address - Street 1:515 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2132
Practice Address - Country:US
Practice Address - Phone:319-366-2225
Practice Address - Fax:319-366-1726
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor