Provider Demographics
NPI:1962439430
Name:MOSES, NORA R (DC)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:R
Last Name:MOSES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 BROADWAY ST N
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4707
Mailing Address - Country:US
Mailing Address - Phone:715-231-4994
Mailing Address - Fax:715-231-2099
Practice Address - Street 1:2321 HWY 25 N STE 6
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751
Practice Address - Country:US
Practice Address - Phone:715-231-4994
Practice Address - Fax:715-231-2099
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3925-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35561Medicare ID - Type Unspecified