Provider Demographics
NPI:1417220880
Name:MOELTER CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:MOELTER CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:SAGE
Authorized Official - Last Name:MOELTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-775-1986
Mailing Address - Street 1:170 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3022
Mailing Address - Country:US
Mailing Address - Phone:802-775-1986
Mailing Address - Fax:802-773-6533
Practice Address - Street 1:170 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3022
Practice Address - Country:US
Practice Address - Phone:802-775-1986
Practice Address - Fax:802-773-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0000642111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT8765Medicare PIN