Provider Demographics
NPI:1528365806
Name:MALLEN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MALLEN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-588-7780
Mailing Address - Street 1:7420 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-4812
Mailing Address - Country:US
Mailing Address - Phone:561-588-7780
Mailing Address - Fax:561-588-9655
Practice Address - Street 1:7420 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-4812
Practice Address - Country:US
Practice Address - Phone:561-588-7780
Practice Address - Fax:561-588-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty