Provider Demographics
NPI:1689816761
Name:MOLITOR, SHANE NATE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:NATE
Last Name:MOLITOR
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 1:1157 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4045
Mailing Address - Country:US
Mailing Address - Phone:563-676-8851
Mailing Address - Fax:
Practice Address - Street 1:317 1ST ST S
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:MN
Practice Address - Zip Code:56069-1603
Practice Address - Country:US
Practice Address - Phone:507-364-7500
Practice Address - Fax:507-364-7444
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor