Provider Demographics
NPI:1215022678
Name:MOLAK, WALTER JOSEPH JR (DC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOSEPH
Last Name:MOLAK
Suffix:JR
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 1:6363 TAFT STREET,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5959
Mailing Address - Country:US
Mailing Address - Phone:954-966-0007
Mailing Address - Fax:954-966-7472
Practice Address - Street 1:6363 TAFT STREET,
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5959
Practice Address - Country:US
Practice Address - Phone:954-966-0007
Practice Address - Fax:954-966-7472
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001704111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0001704OtherCHIROPRACTIC LIC.
FL88204Medicare ID - Type Unspecified
FLCH0001704OtherCHIROPRACTIC LIC.