Provider Demographics
NPI:1003833047
Name:MOLL CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MOLL CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-940-0773
Mailing Address - Street 1:44820 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2312
Mailing Address - Country:US
Mailing Address - Phone:661-940-0773
Mailing Address - Fax:661-940-6037
Practice Address - Street 1:44820 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2312
Practice Address - Country:US
Practice Address - Phone:661-940-0773
Practice Address - Fax:661-940-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04087Medicare UPIN
CADC10849Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER