Provider Demographics
NPI:1104868322
Name:MALONE, EARL W (DC)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:W
Last Name:MALONE
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 1:455 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2231
Mailing Address - Country:US
Mailing Address - Phone:316-722-2222
Mailing Address - Fax:316-729-4416
Practice Address - Street 1:211 S TYLER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1433
Practice Address - Country:US
Practice Address - Phone:316-722-2222
Practice Address - Fax:316-260-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062205Medicare ID - Type UnspecifiedKS PROVIDER #
KSU54525Medicare UPIN