Provider Demographics
NPI:1902474943
Name:SMALTZ, HENRY (DC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:SMALTZ
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 1:565 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3896
Mailing Address - Country:US
Mailing Address - Phone:812-336-2423
Mailing Address - Fax:812-331-2792
Practice Address - Street 1:565 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3896
Practice Address - Country:US
Practice Address - Phone:812-336-2423
Practice Address - Fax:812-331-2792
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003231A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor