Provider Demographics
NPI:1720084015
Name:MOUA, VINAI (DC)
Entity Type:Individual
Prefix:DR
First Name:VINAI
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 1:42 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-6135
Mailing Address - Country:US
Mailing Address - Phone:828-291-7035
Mailing Address - Fax:
Practice Address - Street 1:42 3RD ST NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6135
Practice Address - Country:US
Practice Address - Phone:828-291-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4627111N00000X
NC3860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN490065100Medicaid
MN350003314Medicare ID - Type Unspecified