Provider Demographics
NPI:1073991857
Name:MOLTZEN, JAMES L
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:MOLTZEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 WEBSTER ST
Mailing Address - Street 2:#250
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2947
Mailing Address - Country:US
Mailing Address - Phone:510-444-7000
Mailing Address - Fax:
Practice Address - Street 1:1956 WEBSTER ST
Practice Address - Street 2:#250
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2947
Practice Address - Country:US
Practice Address - Phone:510-444-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor