Provider Demographics
NPI:1659611432
Name:MOE, CARL JOHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOHAN
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 1:4814 INTERLAKE AVE N
Mailing Address - Street 2:STE C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6772
Mailing Address - Country:US
Mailing Address - Phone:206-652-4807
Mailing Address - Fax:
Practice Address - Street 1:16563 REDMOND WAY
Practice Address - Street 2:SUITE D
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4464
Practice Address - Country:US
Practice Address - Phone:585-738-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60323916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor