Provider Demographics
NPI:1770612566
Name:MALIN, RANDALL F (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:F
Last Name:MALIN
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 1:291 E 4500 S STE B
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3885
Mailing Address - Country:US
Mailing Address - Phone:801-261-2829
Mailing Address - Fax:801-269-1785
Practice Address - Street 1:291 E 4500 S STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3885
Practice Address - Country:US
Practice Address - Phone:801-261-2829
Practice Address - Fax:801-269-1785
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT173695-1202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic