Provider Demographics
NPI:1598858193
Name:MALAVOLTI, NOAH A (DC)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:A
Last Name:MALAVOLTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 PIPERS GAP RD.
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333
Mailing Address - Country:US
Mailing Address - Phone:276-238-2471
Mailing Address - Fax:
Practice Address - Street 1:1135 W LEE HWY
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1525
Practice Address - Country:US
Practice Address - Phone:276-227-0414
Practice Address - Fax:276-227-0416
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA466815OtherPROVIDER NUMBER
VAU87599Medicare UPIN