Provider Demographics
NPI:1205012861
Name:STEVEN D. MOE, INC.
Entity type:Organization
Organization Name:STEVEN D. MOE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-833-3038
Mailing Address - Street 1:6805 FLYING CLOUD DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3418
Mailing Address - Country:US
Mailing Address - Phone:952-833-3038
Mailing Address - Fax:952-833-3040
Practice Address - Street 1:6805 FLYING CLOUD DRIVE
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3418
Practice Address - Country:US
Practice Address - Phone:952-833-3038
Practice Address - Fax:952-833-3040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN D. MOE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MN2122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11814MOOtherBC/BS OF MN
MNC03958Medicare PIN