MEDICARE: DR. MARK MULLANY MOLTHEN D.C.

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	DC14161	CA
2	111NR0400X	Rehabilitation Chiropractor	DC14161	CA
3	111NX0100X	Occupational Health Chiropractor	DC14161	CA

General Provider Information

NPI Number	:	1003988023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK MULLANY MOLTHEN D.C.

Provider Business Mailing Address
First Line	:	6042 N FRESNO ST
Second Line	:	101
City	:	FRESNO
State	:	CA
Zip	:	93710-5279
Country	:	US
Telephone Number	:	559-224-6754
Fax Number	:	559-490-0105

Provider Business Practice Location Address
First Line	:	6042 N FRESNO ST
Second Line	:	101
City	:	FRESNO
State	:	CA
Zip	:	93710-5279
Country	:	US
Telephone Number	:	559-224-6754
Fax Number	:	559-490-0105

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	09/11/2025

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