Provider Demographics
NPI:1023033362
Name:MOLTHEN, DAVID A (D C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:MOLTHEN
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 1:14742 PLAZA DR
Mailing Address - Street 2:STE 101
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-8010
Mailing Address - Country:US
Mailing Address - Phone:714-838-1255
Mailing Address - Fax:714-838-5784
Practice Address - Street 1:14742 PLAZA DR
Practice Address - Street 2:STE 101
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-8010
Practice Address - Country:US
Practice Address - Phone:714-838-1255
Practice Address - Fax:714-838-5784
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC8967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0089670OtherBLUE SHIELD IDENTIFIER
CAWDC8967AMedicare PIN
CADC0089670OtherBLUE SHIELD IDENTIFIER