Physician Compare National (NPI:1164805750)

HEALTHCARE PROVIDER: JOHN KNOX MALTBY II D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1164805750
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2062720287
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170522001502
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MALTBY
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Name Suffix Text	II
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LIFE CHIROPRACTIC COLLEGE - WEST
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1299 E IRON EAGLE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 130
	Group Practice or individual's line 2 address
City	EAGLE
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	836166869
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2089226612
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M