MEDICARE: MR. JOHN CARL MOLTHEN 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	DC26904	CA

General Provider Information

NPI Number	:	1568479806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CARL MOLTHEN DC

Provider Business Mailing Address
First Line	:	505 ELM AVE
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95351
Country	:	US
Telephone Number	:	209-526-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	4795 E STATE ROUTE 88
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95215
Country	:	US
Telephone Number	:	209-931-3304
Fax Number	:	209-931-3324

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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