Provider Demographics
NPI:1770980302
Name:MALTBY, JENNIFER (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MALTBY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 E IRON EAGLE DR
Mailing Address - Street 2:STE 130
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6869
Mailing Address - Country:US
Mailing Address - Phone:208-939-6100
Mailing Address - Fax:208-425-6585
Practice Address - Street 1:1299 E IRON EAGLE DR
Practice Address - Street 2:STE 130
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6869
Practice Address - Country:US
Practice Address - Phone:208-939-6100
Practice Address - Fax:208-425-6585
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8435111N00000X
IDCHIA-1759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor