Provider Demographics
NPI:1255580395
Name:NOLAND, MALLON GAVIN (DC)
Entity type:Individual
Prefix:DR
First Name:MALLON
Middle Name:GAVIN
Last Name:NOLAND
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 1:3205 CORNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2377
Mailing Address - Country:US
Mailing Address - Phone:972-423-6900
Mailing Address - Fax:
Practice Address - Street 1:111 S KENTUCKY ST # 208
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-4409
Practice Address - Country:US
Practice Address - Phone:972-741-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor