Provider Demographics
NPI:1417973322
Name:MALTBY, JOHN KNOX (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KNOX
Last Name:MALTBY
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 E HOBSONWAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1733
Mailing Address - Country:US
Mailing Address - Phone:760-922-7353
Mailing Address - Fax:760-922-9121
Practice Address - Street 1:320 E HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1733
Practice Address - Country:US
Practice Address - Phone:760-922-7353
Practice Address - Fax:760-922-9121
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA350055075OtherRAILROAD RETIREMENT
T04570Medicare UPIN
CADC0119710Medicare ID - Type Unspecified