Provider Demographics
NPI:1619941507
Name:MOLIN, SCOTT A (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:MOLIN
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 1:2206 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
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001131A111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100185720AMedicaid
IN000000090250OtherANTHEM/BC/BS #
IN350056122OtherRAILROAD MEDICARE
IN100185720AMedicaid
IN000000090250OtherANTHEM/BC/BS #