Provider Demographics
NPI:1942434337
Name:MALINOWSKI, KEITH (DC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:MALINOWSKI
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 1:2612 ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2834
Mailing Address - Country:US
Mailing Address - Phone:732-899-0016
Mailing Address - Fax:732-899-0116
Practice Address - Street 1:2612 ROUTE 88
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742-2834
Practice Address - Country:US
Practice Address - Phone:732-899-0016
Practice Address - Fax:732-899-0116
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00667600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor