Provider Demographics
NPI:1568479806
Name:MOLTHEN, JOHN CARL (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CARL
Last Name:MOLTHEN
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 1:505 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351
Mailing Address - Country:US
Mailing Address - Phone:209-526-3839
Mailing Address - Fax:
Practice Address - Street 1:4795 E STATE ROUTE 88
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215
Practice Address - Country:US
Practice Address - Phone:209-931-3304
Practice Address - Fax:209-931-3324
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0269040Medicare ID - Type Unspecified