Provider Demographics
NPI:1114083805
Name:KALTINGER, EDELMIRA (DC)
Entity Type:Individual
Prefix:
First Name:EDELMIRA
Middle Name:
Last Name:KALTINGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8904 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-2006
Mailing Address - Country:US
Mailing Address - Phone:708-485-4335
Mailing Address - Fax:708-485-4233
Practice Address - Street 1:8904 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-2006
Practice Address - Country:US
Practice Address - Phone:708-485-4335
Practice Address - Fax:708-485-4233
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007133111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL788670Medicare ID - Type Unspecified