Provider Demographics
NPI:1942597117
Name:KALTENBACH, MARY RUTH (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RUTH
Last Name:KALTENBACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 SAN BENITO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-1912
Mailing Address - Country:US
Mailing Address - Phone:805-350-0578
Mailing Address - Fax:
Practice Address - Street 1:5570 SAN BENITO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-1912
Practice Address - Country:US
Practice Address - Phone:805-350-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22022111N00000X
NYX007124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor