Provider Demographics
NPI:1215365911
Name:MALONE HEALTH AND FITNESS
Entity Type:Organization
Organization Name:MALONE HEALTH AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-327-1325
Mailing Address - Street 1:17510 S BROADWAY
Mailing Address - Street 2:UNIT D
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3501
Mailing Address - Country:US
Mailing Address - Phone:310-327-1325
Mailing Address - Fax:310-327-7058
Practice Address - Street 1:17510 S BROADWAY
Practice Address - Street 2:UNIT D
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3501
Practice Address - Country:US
Practice Address - Phone:310-327-1325
Practice Address - Fax:310-327-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty