Provider Demographics
NPI:1528188612
Name:MALTZ, RONNIE (DC)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:MALTZ
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:PO BOX 665
Mailing Address - Street 2:5872 YORK RD.
Mailing Address - City:LAHASKA
Mailing Address - State:PA
Mailing Address - Zip Code:18931-0665
Mailing Address - Country:US
Mailing Address - Phone:215-794-8028
Mailing Address - Fax:
Practice Address - Street 1:5872 YORK RD.
Practice Address - Street 2:
Practice Address - City:LAHASKA
Practice Address - State:PA
Practice Address - Zip Code:18931-0665
Practice Address - Country:US
Practice Address - Phone:215-794-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002181L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0023347000OtherBLUE SHIELD PIN
PA407162Medicare PIN