Individual provider Active NPI

Larrnix Moua, DC

  • Chiropractor
  • Shakopee, MN
National Provider Identifier
1639775448
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6712 Issued in MN
Practice address
4109 Dean Lakes Blvd
Shakopee, MN 55379-2851
Phone
(612) 767-2800
NPI assigned
Dec 7, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 6712 MN Primary

Addresses

Primary practice location

4109 Dean Lakes Blvd
Shakopee, MN 55379-2851

Mailing address

4109 Dean Lakes Blvd
Shakopee, MN 55379-2851
Phone (715) 379-2753

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250428001764 MN Practitioner - Chiropractic 0749704229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4109 Dean Lakes Blvd
Shakopee, MN 55379-2851
Phone (612) 767-2800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6712MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mission Chiropractic & Acupuncture PLLC Chiropractor CurrentSince Feb 2, 2025 Accepting new patients
Jo G Theisen DC, PA Chiropractor Past Accepting new patients

Locations

4109 Dean Lakes Blvd
Shakopee, MN 55379
Phone (612) 767-2800

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1639775448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4109 DEAN LAKES BLVD",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792851",
            "telephone_number": "715-379-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4109 DEAN LAKES BLVD",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792851",
            "telephone_number": "612-767-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUA",
        "first_name": "LARRNIX",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-07",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shakopee, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; 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.