Healthcare Provider Details

I. General information

NPI: 1417973322
Provider Name (Legal Business Name): JOHN KNOX MALTBY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E HOBSONWAY
BLYTHE CA
92225-1733
US

IV. Provider business mailing address

320 E HOBSONWAY
BLYTHE CA
92225-1733
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-7353
  • Fax: 760-922-9121
Mailing address:
  • Phone: 760-922-7353
  • Fax: 760-922-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC11971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: