MEDICARE: JOHN MOLDTHAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH14528	FL

General Provider Information

NPI Number	:	1578346896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MOLDTHAN DC

Provider Business Mailing Address
First Line	:	959 WEST AVE STE 17
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-5214
Country	:	US
Telephone Number	:	305-507-5220
Fax Number	:	305-503-6921

Provider Business Practice Location Address
First Line	:	959 WEST AVE STE 17
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-5214
Country	:	US
Telephone Number	:	305-507-5220
Fax Number	:	305-503-6921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/18/2023

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Directions to “ JOHN MOLDTHAN DC” Practice Location

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