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General NPI Number Information
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NPI Number | 1770840472
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Entity Type | Organization
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Legal Business Name | MALTESE CHIROPRACTIC LIFE CENTER, P.C.
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 900 INDIAN TRAIL LILBURN RD NW STE 9
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City | LILBURN
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State | GA
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Zip | 30047-6869
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Country | US
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Telephone | 770-381-0491
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Fax |
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Provider Business Mailing Address
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Address Line | 900 INDIAN TRAIL LILBURN RD NW STE 9
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City | LILBURN
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State | GA
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Zip | 30047-6869
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Country | US
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Telephone | 770-381-0491
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN P. MALTESE
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Credential | D.C.
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Telephone | 770-381-0491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHIR02313
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License Number State | GA
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