Provider Demographics
NPI:1942328323
Name:DOLTER, LARRY LESTER (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LESTER
Last Name:DOLTER
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: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
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002314L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008440720002Medicaid
PA1014562OtherGATEWAY
PA65584OtherMED PLUS
U00408Medicare UPIN
PA65584OtherMED PLUS