Provider Demographics
NPI:1134157993
Name:MALON, MARC G (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:G
Last Name:MALON
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 1:322 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3032
Mailing Address - Country:US
Mailing Address - Phone:207-283-0104
Mailing Address - Fax:207-283-4322
Practice Address - Street 1:322 ELM ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3032
Practice Address - Country:US
Practice Address - Phone:207-283-0104
Practice Address - Fax:207-283-4322
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME112320099Medicaid
0024542OtherCIGNA (NATIONAL)
000569OtherANTHEM BC/BS
M3730OtherCIGNA (HEALTHSOURCE)
T31532OtherHARVARD PILGRIM
0005492619OtherAETNA--NON-HMO
2583235OtherAETNA--HMO
T31532OtherHARVARD PILGRIM
ME112320099Medicaid