Provider Demographics
NPI:1548355142
Name:MOUA-LOR, YER (DC)
Entity type:Individual
Prefix:DR
First Name:YER
Middle Name:
Last Name:MOUA-LOR
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 1:5600 BASS LAKE RD STE D
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2722
Mailing Address - Country:US
Mailing Address - Phone:612-529-0202
Mailing Address - Fax:612-521-1445
Practice Address - Street 1:5600 BASS LAKE RD STE D
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2722
Practice Address - Country:US
Practice Address - Phone:612-529-0202
Practice Address - Fax:612-521-1445
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN539171100000X
MN4013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245957400Medicaid
MN245957400Medicaid
MN350002930Medicare ID - Type UnspecifiedMEDICARE NUMBER