Provider Demographics
NPI:1114011822
Name:MOLSTRE, TYLER (DC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MOLSTRE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 UNIVERSITY AVENUE
Mailing Address - Street 2:118
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263
Mailing Address - Country:US
Mailing Address - Phone:515-225-2266
Mailing Address - Fax:515-225-2296
Practice Address - Street 1:14225 UNIVERSITY AVENUE
Practice Address - Street 2:118
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-225-2266
Practice Address - Fax:515-225-2296
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
IA06767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor