Paul Daeboo Moon, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC3736 Issued in MN

Practice address

10700 Highway 55 Ste 100
Plymouth, MN 55441-6130

Phone

(763) 543-9080

Fax

(763) 543-9082

NPI assigned

Nov 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Y-Chiropractic

  • Clinic/Center
  • Plymouth, MN
  • NPI 1275711764
  Medicare reassignment Authorized official
• Lighthouse Chiropractic, PA

  • Chiropractor
  • Plymouth, MN
  • NPI 1427353093
  NPD

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871663815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10700 HIGHWAY 55 STE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416130",
            "telephone_number": "763-543-9080",
            "fax_number": "763-543-9082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 HIGHWAY 55 STE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416130",
            "telephone_number": "763-543-9080",
            "fax_number": "763-543-9082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "PAUL",
        "middle_name": "DAEBOO",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "DC3736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mondale Dental LLC
• Roger Alan Mondale, D.D S.
• Benjamin Monseth
• Amanda Beth Monson, DNP, APRN, CRNA
• Sandra Rocio Montezuma, M.D.
• Derryck Vancurk Moore, LADC
• Kelsey Moore, OD
• Leah Moore
• Sara Nikolai Moore
• Jose Maria Moraes de Souza Junior, MD

• Chiropractor in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.