Provider Demographics
NPI:1790968709
Name:AARON ALAN MALAVOLTI DC SC
Entity Type:Organization
Organization Name:AARON ALAN MALAVOLTI DC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MALAVOLTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-575-5112
Mailing Address - Street 1:21 W ELM ST
Mailing Address - Street 2:LOWER LEVEL W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6420
Mailing Address - Country:US
Mailing Address - Phone:312-643-1222
Mailing Address - Fax:312-643-1885
Practice Address - Street 1:21 W ELM ST
Practice Address - Street 2:LOWER LEVEL W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6420
Practice Address - Country:US
Practice Address - Phone:312-643-1222
Practice Address - Fax:312-643-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009815305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization