Provider Demographics
NPI:1487788063
Name:MULDOON, JOSEPH HAMILTON (D,C,)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HAMILTON
Last Name:MULDOON
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-1314
Mailing Address - Country:US
Mailing Address - Phone:507-836-8971
Mailing Address - Fax:507-836-8972
Practice Address - Street 1:2710 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1314
Practice Address - Country:US
Practice Address - Phone:507-836-8971
Practice Address - Fax:507-836-8972
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2963111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU33904Medicare UPIN