Provider Demographics
NPI:1407510019
Name:BIETZ, MOLLY E (DC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:BIETZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:E
Other - Last Name:WOODRUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 WAPELLO ST N
Mailing Address - Street 2:
Mailing Address - City:MEDIAPOLIS
Mailing Address - State:IA
Mailing Address - Zip Code:52637-4900
Mailing Address - Country:US
Mailing Address - Phone:319-394-9120
Mailing Address - Fax:
Practice Address - Street 1:214 WAPELLO ST N
Practice Address - Street 2:
Practice Address - City:MEDIAPOLIS
Practice Address - State:IA
Practice Address - Zip Code:52637-4900
Practice Address - Country:US
Practice Address - Phone:319-394-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor