Provider Demographics
NPI:1467931048
Name:MCQUILLEN, MALLORY PAGE (DC)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:PAGE
Last Name:MCQUILLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2382
Mailing Address - Country:US
Mailing Address - Phone:781-829-6780
Mailing Address - Fax:781-829-6781
Practice Address - Street 1:208 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2382
Practice Address - Country:US
Practice Address - Phone:781-829-6780
Practice Address - Fax:781-829-6781
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor