Provider Demographics
NPI:1619109360
Name:MALCHAK, LEILA (DA HOM, ND)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:MALCHAK
Suffix:
Gender:F
Credentials:DA HOM, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3622
Mailing Address - Country:US
Mailing Address - Phone:770-653-9183
Mailing Address - Fax:
Practice Address - Street 1:145 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-3622
Practice Address - Country:US
Practice Address - Phone:770-653-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath