Provider Demographics
NPI:1366769259
Name:MOLDAN, ANTHONY JEROME (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JEROME
Last Name:MOLDAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 STADIUM RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5165
Mailing Address - Country:US
Mailing Address - Phone:507-387-7463
Mailing Address - Fax:
Practice Address - Street 1:320 STADIUM RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5165
Practice Address - Country:US
Practice Address - Phone:507-387-7463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor