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General NPI Number Information
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NPI Number | 1770980302
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Entity Type | Individual
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Provider Name | JENNIFER MALTBY D.C.
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Gender | Female
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 1299 E IRON EAGLE DR STE 130
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City | EAGLE
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State | ID
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Zip | 83616-6869
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Country | US
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Telephone | 208-939-6100
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Fax | 208-425-6585
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Provider Business Mailing Address
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Address Line | 1299 E IRON EAGLE DR STE 130
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City | EAGLE
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State | ID
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Zip | 83616-6869
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Country | US
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Telephone | 208-939-6100
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Fax | 208-425-6585
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8435
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-1759
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License Number State | ID
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