Provider Demographics
NPI:1841218500
Name:MALKIEL, REUBEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:M
Last Name:MALKIEL
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 1:970 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5542
Mailing Address - Country:US
Mailing Address - Phone:203-348-0123
Mailing Address - Fax:203-348-5678
Practice Address - Street 1:970 SUMMER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5542
Practice Address - Country:US
Practice Address - Phone:203-348-0123
Practice Address - Fax:203-348-5678
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82465Medicare UPIN
CT350001098Medicare ID - Type Unspecified