1578617767 NPI number — MOLSTAD CHIROPRACTIC CLINIC

Table of content: (NPI 1578617767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578617767 NPI number — MOLSTAD CHIROPRACTIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOLSTAD CHIROPRACTIC CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578617767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1206 MORNINGSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51106-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-276-7742
Provider Business Mailing Address Fax Number:
712-276-9210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 MORNINGSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51106-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-276-7742
Provider Business Practice Location Address Fax Number:
712-276-9210
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOLSTAD
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
DOCTOR ASSOCIATE
Authorized Official Telephone Number:
712-276-7742

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2434 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: A5877 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 37574 . This is a "WELLMARK GROUP NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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