Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-27941 | CA |
NPI | 1003959867 |
---|---|
Provider Name | Dr. Michael John Molter |
First Address | San Jose, CA 95129-3846 |
Second Address | San Jose, CA 95129-3846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC-27941 | STATE LICENSE # (01) | CA |
V01124 | (02) | CA |