Provider Demographics
NPI:1043757610
Name:MALONE, ROBERT SCOTT (LAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:MALONE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 W 6TH AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1870
Mailing Address - Country:US
Mailing Address - Phone:720-313-4735
Mailing Address - Fax:
Practice Address - Street 1:2095 W 6TH AVE
Practice Address - Street 2:STE 115
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1870
Practice Address - Country:US
Practice Address - Phone:720-313-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0000887171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist