Provider Demographics
NPI:1659567105
Name:MOLDENHAUER, BRET (L AC, D AC)
Entity Type:Individual
Prefix:MR
First Name:BRET
Middle Name:
Last Name:MOLDENHAUER
Suffix:
Gender:M
Credentials:L AC, D AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MARKET ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1226
Mailing Address - Country:US
Mailing Address - Phone:423-778-9407
Mailing Address - Fax:423-778-9403
Practice Address - Street 1:325 MARKET ST STE 203
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-1226
Practice Address - Country:US
Practice Address - Phone:423-778-9407
Practice Address - Fax:423-778-9403
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU0000000009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist