Provider Demographics
NPI:1871668541
Name:MOLFETTO, JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MOLFETTO
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 1:29055 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2964
Mailing Address - Country:US
Mailing Address - Phone:734-422-1980
Mailing Address - Fax:734-422-2249
Practice Address - Street 1:29055 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2964
Practice Address - Country:US
Practice Address - Phone:734-422-1980
Practice Address - Fax:734-422-2249
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM004741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1655418Medicaid
MI0H25035Medicare ID - Type Unspecified
MI1655418Medicaid