Provider Demographics
NPI:1659731230
Name:NICK C. MALLIOS DC, LTD
Entity Type:Organization
Organization Name:NICK C. MALLIOS DC, LTD
Other - Org Name:APPLIED WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALLIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-489-3700
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty