Provider Demographics
NPI:1952455578
Name:MOLBERG, MICHELLE NOREEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NOREEN
Last Name:MOLBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2060
Mailing Address - Country:US
Mailing Address - Phone:602-265-7521
Mailing Address - Fax:602-265-7521
Practice Address - Street 1:5150 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2060
Practice Address - Country:US
Practice Address - Phone:602-265-7521
Practice Address - Fax:602-265-7521
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2480363OtherAETNA
AZ3681OtherLICENSENUMBER
9557425OtherGHI
AZAZ0242260OtherBLUE CROSS
WI1435OtherLICENSE NUMBER
T62796Medicare UPIN
WI1435OtherLICENSE NUMBER