Provider Demographics
NPI:1639441843
Name:MALLIOS, NICK C (DC)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:C
Last Name:MALLIOS
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 1:13301 S RIDGELAND AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-0030
Mailing Address - Country:US
Mailing Address - Phone:708-489-3700
Mailing Address - Fax:708-489-3705
Practice Address - Street 1:13301 S RIDGELAND AVE UNIT A
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-0030
Practice Address - Country:US
Practice Address - Phone:708-489-3700
Practice Address - Fax:708-489-3705
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor