Provider Demographics
NPI:1265752216
Name:MALON CHIROPRACTIC CENTRE LLC
Entity type:Organization
Organization Name:MALON CHIROPRACTIC CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:G
Authorized Official - Last Name:MALON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-283-0104
Mailing Address - Street 1:322 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3009
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:04005-3009
Practice Address - Country:US
Practice Address - Phone:207-283-0104
Practice Address - Fax:207-283-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME112320000Medicaid