Provider Demographics
NPI:1376934075
Name:MALETTA CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MALETTA CHIROPRACTIC PLLC
Other - Org Name:PROACTIVE CHIROPRACTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MALETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-399-6624
Mailing Address - Street 1:2863 W SHORE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9576
Mailing Address - Country:US
Mailing Address - Phone:616-399-6624
Mailing Address - Fax:
Practice Address - Street 1:2863 W SHORE DR STE 114
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9576
Practice Address - Country:US
Practice Address - Phone:616-399-6624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010295111N00000X
111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty