Provider Demographics
NPI:1356710479
Name:MALOY, ANDREW D (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:MALOY
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 1:11806 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-1402
Mailing Address - Country:US
Mailing Address - Phone:573-808-0370
Mailing Address - Fax:
Practice Address - Street 1:12100 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1201
Practice Address - Country:US
Practice Address - Phone:913-345-9888
Practice Address - Fax:913-345-0958
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016033334111N00000X
KS01-05748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor