Healthcare Provider Details

I. General information

NPI: 1346403763
Provider Name (Legal Business Name): LUKE MOLITOR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5590 SPRING VALLEY RD G202
DALLAS TX
75254-3054
US

IV. Provider business mailing address

5590 SPRING VALLEY RD G202
DALLAS TX
75254-3054
US

V. Phone/Fax

Practice location:
  • Phone: 469-878-5853
  • Fax:
Mailing address:
  • Phone: 469-878-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10925
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number10925
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: