Provider Demographics
NPI:1669140968
Name:MOUA, CHIA (DC)
Entity type:Individual
Prefix:
First Name:CHIA
Middle Name:
Last Name:MOUA
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 1:1118 PILGRIM WAY APT C
Mailing Address - Street 2:
Mailing Address - City:ASHWAUBENON
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5833
Mailing Address - Country:US
Mailing Address - Phone:920-254-0227
Mailing Address - Fax:
Practice Address - Street 1:926 WILLARD DR STE 218
Practice Address - Street 2:
Practice Address - City:ASHWAUBENON
Practice Address - State:WI
Practice Address - Zip Code:54304-5071
Practice Address - Country:US
Practice Address - Phone:920-316-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5626-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor