Provider Demographics
NPI:1457156366
Name:MISSION CHIROPRACTIC & ACUPUNCTURE PLLC
Entity type:Organization
Organization Name:MISSION CHIROPRACTIC & ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRNIX
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-767-2800
Mailing Address - Street 1:4109 DEAN LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2851
Mailing Address - Country:US
Mailing Address - Phone:612-767-2800
Mailing Address - Fax:
Practice Address - Street 1:4109 DEAN LAKES BLVD
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2851
Practice Address - Country:US
Practice Address - Phone:612-767-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty