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General NPI Number Information
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NPI Number | 1417075896
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Entity Type | Organization
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Legal Business Name | DOLTER CHIROPRACTIC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | RT 288 310 2
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City | ELLWOOD CITY
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State | PA
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Zip | 16117
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Country | US
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Telephone | 724-758-4711
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Fax | 724-758-9619
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Provider Business Mailing Address
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Address Line | RT 288 310 2
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City | ELLWOOD CITY
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State | PA
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Zip | 16117
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Country | US
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Telephone | 724-758-4711
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Fax | 724-758-9619
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARRY LESTER DOLTER
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Credential | DC
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Telephone | 724-758-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC002314L
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License Number State | PA
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