MEDICARE: MOLSTAD CHIROPRACTIC CLINIC

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	2434	IA
2	111N00000X	Chiropractor	A5877	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37574	OTHER	IA	WELLMARK GROUP NUMBER

General Provider Information

NPI Number	:	1578617767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLSTAD CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	1206 MORNINGSIDE AVE
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-1707
Country	:	US
Telephone Number	:	712-276-7742
Fax Number	:	712-276-9210

Provider Business Practice Location Address
First Line	:	1206 MORNINGSIDE AVE
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-1707
Country	:	US
Telephone Number	:	712-276-7742
Fax Number	:	712-276-9210

Authorized Official
Title or Position	:	DOCTOR ASSOCIATE
Name	:	DR. THOMAS ALAN MOLSTAD
Credential	:	DC
Telephone Number	:	712-276-7742

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	10/09/2007

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Directions to “MOLSTAD CHIROPRACTIC CLINIC ” Practice Location

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