Individual provider Active NPI

Yer Moua-Lor, D.C.

  • Chiropractor
  • Crystal, MN
National Provider Identifier
1548355142
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4013 Issued in MN
Practice address
5600 Bass Lake Rd Ste D
Crystal, MN 55429-2722
Phone
(612) 529-0202
Fax
(612) 521-1445
NPI assigned
Oct 3, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 539 MN
Chiropractor 111N00000X 4013 MN Primary

Addresses

Primary practice location

5600 Bass Lake Rd Ste D
Crystal, MN 55429-2722

Mailing address

5600 Bass Lake Rd Ste D
Crystal, MN 55429-2722
Phone (612) 529-0202

Other identifiers 1

IdentifierTypeStateIssuer
245957400MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120518000601 MN Practitioner - Chiropractic 6002079555

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2000
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5600 Bass Lake Rd
Suite D
Crystal, MN 55429-2722

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4013MNMDOptometrist
539MNMDAcupuncturist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1548355142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 BASS LAKE RD STE D",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554292722",
            "telephone_number": "612-529-0202",
            "fax_number": "612-521-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 BASS LAKE RD STE D",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554292722",
            "telephone_number": "612-529-0202",
            "fax_number": "612-521-1445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUA-LOR",
        "first_name": "YER",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MN",
            "license": "539",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "245957400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.