Provider Demographics
NPI:1215061155
Name:MALTESE, JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MALTESE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 INDIAN TRAIL LILBURN RD NW STE 9
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6869
Mailing Address - Country:US
Mailing Address - Phone:770-381-0491
Mailing Address - Fax:
Practice Address - Street 1:900 INDIAN TRAIL LILBURN RD NW STE 9
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6869
Practice Address - Country:US
Practice Address - Phone:770-381-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582160094OtherTAX ID NUMBER