Provider Demographics
NPI:1871851329
Name:MOUA-LOR CHIROPRACTIC AND ACUPUNCTURE, PA
Entity Type:Organization
Organization Name:MOUA-LOR CHIROPRACTIC AND ACUPUNCTURE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUA-LOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-529-0202
Mailing Address - Street 1:5600 BASS LAKE RD STE D
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2722
Mailing Address - Country:US
Mailing Address - Phone:612-529-0202
Mailing Address - Fax:612-521-1445
Practice Address - Street 1:5600 BASS LAKE RD STE D
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2722
Practice Address - Country:US
Practice Address - Phone:612-529-0202
Practice Address - Fax:612-521-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4013261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center