Provider Demographics
NPI:1578617767
Name:MOLSTAD CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MOLSTAD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-276-7742
Mailing Address - Street 1:1206 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-1707
Mailing Address - Country:US
Mailing Address - Phone:712-276-7742
Mailing Address - Fax:712-276-9210
Practice Address - Street 1:1206 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-1707
Practice Address - Country:US
Practice Address - Phone:712-276-7742
Practice Address - Fax:712-276-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2434111N00000X
IAA5877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37574OtherWELLMARK GROUP NUMBER
IA37574OtherWELLMARK GROUP NUMBER