Provider Demographics
NPI:1669423729
Name:MALLORY, CHRISTOPHER DARRELL (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DARRELL
Last Name:MALLORY
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 1:11701 NE 95TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2318
Mailing Address - Country:US
Mailing Address - Phone:360-892-7202
Mailing Address - Fax:360-892-7382
Practice Address - Street 1:11701 NE 95TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-2318
Practice Address - Country:US
Practice Address - Phone:360-892-7202
Practice Address - Fax:360-892-7382
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8879340Medicare PIN
U12347Medicare UPIN