Provider Demographics
NPI:1851469217
Name:MALONE, JEFFREY J (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:MALONE
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 1:4418 VINELAND AVE
Mailing Address - Street 2:STE 215
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2159
Mailing Address - Country:US
Mailing Address - Phone:818-752-1136
Mailing Address - Fax:
Practice Address - Street 1:4418 VINELAND AVE
Practice Address - Street 2:STE 215
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2159
Practice Address - Country:US
Practice Address - Phone:818-752-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23895111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU68289Medicare UPIN