Provider Demographics
NPI:1760961825
Name:MALLIK, MONISHA K (DC)
Entity Type:Individual
Prefix:
First Name:MONISHA
Middle Name:K
Last Name:MALLIK
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 1:10169 WELLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7671
Mailing Address - Country:US
Mailing Address - Phone:312-350-4665
Mailing Address - Fax:
Practice Address - Street 1:1156 DUBLIN RD STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1095
Practice Address - Country:US
Practice Address - Phone:614-407-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty