Provider Demographics
NPI:1093809709
Name:MOLTHEN, KELLI LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:LYNN
Last Name:MOLTHEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 ADENMOOR AVE.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713
Mailing Address - Country:US
Mailing Address - Phone:562-865-4515
Mailing Address - Fax:562-925-1269
Practice Address - Street 1:5834 ADENMOOR AVE.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713
Practice Address - Country:US
Practice Address - Phone:562-865-4515
Practice Address - Fax:562-925-1269
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV03062Medicare UPIN
CADC24516Medicare ID - Type UnspecifiedPROVIDER ID