Provider Demographics
NPI:1265865794
Name:MALTA CHIROPRACTIC & NUTRITION, INC.
Entity Type:Organization
Organization Name:MALTA CHIROPRACTIC & NUTRITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:512-534-5740
Mailing Address - Street 1:401 S STATE ST
Mailing Address - Street 2:SUITE 1, PO BOX 424
Mailing Address - City:DENVER
Mailing Address - State:IA
Mailing Address - Zip Code:50622-7715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:319-423-6155
Practice Address - Street 1:401 S STATE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DENVER
Practice Address - State:IA
Practice Address - Zip Code:50622-7715
Practice Address - Country:US
Practice Address - Phone:512-534-5740
Practice Address - Fax:319-423-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007412111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty