Provider Demographics
NPI:1164805750
Name:MALTBY, JOHN KNOX II (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KNOX
Last Name:MALTBY
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1299 E IRON EAGLE DR
Mailing Address - Street 2:STE 130
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6869
Mailing Address - Country:US
Mailing Address - Phone:208-939-6100
Mailing Address - Fax:208-425-6585
Practice Address - Street 1:1299 E IRON EAGLE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6869
Practice Address - Country:US
Practice Address - Phone:208-939-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33328111N00000X
IDCHIA-1760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor