Provider Demographics
NPI:1508987587
Name:MOLIN CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MOLIN CHIROPRACTIC, P.C.
Other - Org Name:NORTHRIDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-362-0123
Mailing Address - Street 1:2206 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1043
Mailing Address - Country:US
Mailing Address - Phone:765-362-0123
Mailing Address - Fax:765-362-8479
Practice Address - Street 1:2206 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1043
Practice Address - Country:US
Practice Address - Phone:765-362-0123
Practice Address - Fax:765-362-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001131111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1619941507OtherDR. SCOTT A. MOLIN
IN100185720AMedicaid
IN000000090250OtherBC & BS ID
IN=========OtherTAX ID
IN100185720AMedicaid
IN=========OtherTAX ID