Provider Demographics
NPI:1477517985
Name:MOLINA, RICHARD JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:MOLINA
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 1:75-240 NANI KAILUA DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2074
Mailing Address - Country:US
Mailing Address - Phone:808-331-8333
Mailing Address - Fax:949-606-0377
Practice Address - Street 1:75-240 NANI KAILUA DR
Practice Address - Street 2:SUITE 3
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2074
Practice Address - Country:US
Practice Address - Phone:808-331-8333
Practice Address - Fax:949-606-0377
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2589712OtherAETNA HMO/POS
CA1021340OtherAMERICAN SPECIALTY HEALTH
CADC0233260Medicaid
CA0007293269OtherAETNA TRAD/EPO
CADC0233260Medicaid
CAU84797Medicare UPIN