Provider Demographics
NPI:1508922998
Name:MALNIKOF, VIVIAN K (DC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:K
Last Name:MALNIKOF
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 1:46169 WESTLAKE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5875
Mailing Address - Country:US
Mailing Address - Phone:703-421-2990
Mailing Address - Fax:703-421-2822
Practice Address - Street 1:46169 WESTLAKE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5875
Practice Address - Country:US
Practice Address - Phone:703-421-2990
Practice Address - Fax:703-421-2822
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001295OtherMEDICARE