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Organization

MOLDENHAUER CHIROPRACTIC CENTER PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GLENN W MOLDENHAUER D.C. (OWNER)
(208) 467-5759
Entity
Organization

Contact information

Practice address
228 HOLLY ST, NAMPA, ID 83686-5104
(208) 467-5759
(208) 467-4510
Mailing address
228 HOLLY ST, NAMPA, ID 83686-5104
(208) 467-5759
(208) 467-4510

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA296
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010008275
BLUE SHIELD
ID
05
002554100
ID
01
C9420
BLUE CROSS
ID
01
CK7825
MEDICARE RAILROAD
ID
Enumeration date
09/27/2007
Last updated
03/16/2009
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