Provider Demographics
NPI:1235781196
Name:SPOHN, MOLLY DANIELLE (DC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:DANIELLE
Last Name:SPOHN
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 1:107 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4017
Mailing Address - Country:US
Mailing Address - Phone:765-580-2352
Mailing Address - Fax:
Practice Address - Street 1:107 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4017
Practice Address - Country:US
Practice Address - Phone:864-263-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor