Provider Demographics
NPI:1700916905
Name:MALETICH, TODD ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANDREW
Last Name:MALETICH
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:PO BOX 3263
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-3263
Mailing Address - Country:US
Mailing Address - Phone:678-777-5432
Mailing Address - Fax:
Practice Address - Street 1:3885 SHALLOWFORD RD.
Practice Address - Street 2:210
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:678-777-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor