Provider Demographics
NPI:1417075896
Name:DOLTER CHIROPRACTIC
Entity Type:Organization
Organization Name:DOLTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:DOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-758-4711
Mailing Address - Street 1:RT 288 310 2
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117
Mailing Address - Country:US
Mailing Address - Phone:724-758-4711
Mailing Address - Fax:724-758-9619
Practice Address - Street 1:RT 288 310 2
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117
Practice Address - Country:US
Practice Address - Phone:724-758-4711
Practice Address - Fax:724-758-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002314L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA65584OtherMEDPLUS
PA0008440720002Medicaid
PA1014562OtherGATEWAY
PA1014562OtherGATEWAY
PA0008440720002Medicaid