Provider Demographics
NPI:1942231147
Name:MOLENCUPP, DAVID PERRY (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PERRY
Last Name:MOLENCUPP
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 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:4780 SONOMA HWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4237
Practice Address - Country:US
Practice Address - Phone:707-484-6021
Practice Address - Fax:707-539-4528
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0300820OtherPTAN
CADC0300820OtherBLUE SHIELD
CADC30082OtherCHIROPRACTIC LICENSE