Provider Demographics
NPI:1063570661
Name:MALTER CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:MALTER CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-254-3303
Mailing Address - Street 1:45280 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5600
Mailing Address - Country:US
Mailing Address - Phone:586-254-3303
Mailing Address - Fax:586-254-1121
Practice Address - Street 1:45280 CASS AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5600
Practice Address - Country:US
Practice Address - Phone:586-254-3303
Practice Address - Fax:586-254-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95 0E024980OtherBCBS
MI95 0E052880OtherBCBS
MIE05288001Medicare PIN