Provider Demographics
NPI:1730286329
Name:MALEK, AMY M (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:MALEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4354
Mailing Address - Country:US
Mailing Address - Phone:401-286-6301
Mailing Address - Fax:
Practice Address - Street 1:560 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1836
Practice Address - Country:US
Practice Address - Phone:401-421-1125
Practice Address - Fax:401-421-3951
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2513111N00000X
RIDCP430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92551Medicare UPIN
RI007056953Medicare ID - Type Unspecified