Provider Demographics
NPI:1770840472
Name:MALTESE CHIROPRACTIC LIFE CENTER, P.C.
Entity Type:Organization
Organization Name:MALTESE CHIROPRACTIC LIFE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MALTESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-381-0491
Mailing Address - Street 1:900 INDIAN TRAIL LILBURN RD NW STE 9
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6869
Mailing Address - Country:US
Mailing Address - Phone:770-381-0491
Mailing Address - Fax:
Practice Address - Street 1:900 INDIAN TRAIL LILBURN RD NW STE 9
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6869
Practice Address - Country:US
Practice Address - Phone:770-381-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR02313261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center