Provider Demographics
NPI:1134291099
Name:MALY, TRENTON B (DC)
Entity Type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:B
Last Name:MALY
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 1:4645 NORMAL BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5588
Mailing Address - Country:US
Mailing Address - Phone:402-483-6633
Mailing Address - Fax:402-483-6919
Practice Address - Street 1:4645 NORMAL BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5588
Practice Address - Country:US
Practice Address - Phone:402-483-6633
Practice Address - Fax:402-483-6919
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025679500Medicaid
NEP00163901Medicare ID - Type UnspecifiedMEDICARE RAILROAD
NE10025679500Medicaid