MEDICARE: MOLDENHAUER CHIROPRACTIC CENTER PC

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	CHIA296	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK7825	OTHER	ID	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C9420	OTHER	ID	BLUE CROSS
4	000010008275	OTHER	ID	BLUE SHIELD

General Provider Information

NPI Number	:	1942497532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLDENHAUER CHIROPRACTIC CENTER PC

Provider Business Mailing Address
First Line	:	228 HOLLY ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5104
Country	:	US
Telephone Number	:	208-467-5759
Fax Number	:	208-467-4510

Provider Business Practice Location Address
First Line	:	228 HOLLY ST
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5104
Country	:	US
Telephone Number	:	208-467-5759
Fax Number	:	208-467-4510

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GLENN W MOLDENHAUER
Credential	:	D.C.
Telephone Number	:	208-467-5759

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	03/16/2009

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Directions to “MOLDENHAUER CHIROPRACTIC CENTER PC ” Practice Location

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