Provider Demographics
NPI:1083872055
Name:MALINE, JONATHAN C (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:MALINE
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 1:127 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-1453
Mailing Address - Country:US
Mailing Address - Phone:906-341-6601
Mailing Address - Fax:906-341-5134
Practice Address - Street 1:127 ARBUTUS AVE
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-1453
Practice Address - Country:US
Practice Address - Phone:906-341-6601
Practice Address - Fax:906-341-5134
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1519111N00000X
MI2301010177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor