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General NPI Number Information
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NPI Number | 1417220880
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Entity Type | Organization
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Legal Business Name | MOELTER CHIROPRACTIC CLINIC, P.C.
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 170 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-3022
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Country | US
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Telephone | 802-775-1986
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Fax | 802-773-6533
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Provider Business Mailing Address
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Address Line | 170 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-3022
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Country | US
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Telephone | 802-775-1986
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Fax | 802-773-6533
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDI SAGE MOELTER
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Credential | DC
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Telephone | 802-775-1986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 006.0000642
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License Number State | VT
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