Provider Demographics
NPI:1750599536
Name:JEFFERY J MOLL DC PC
Entity type:Organization
Organization Name:JEFFERY J MOLL DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-769-5411
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-0531
Mailing Address - Country:US
Mailing Address - Phone:503-769-5411
Mailing Address - Fax:
Practice Address - Street 1:1460 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1212
Practice Address - Country:US
Practice Address - Phone:503-769-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty