Provider Demographics
NPI:1780777003
Name:MALLETT, CHETT LEGRAND (DC)
Entity type:Individual
Prefix:DR
First Name:CHETT
Middle Name:LEGRAND
Last Name:MALLETT
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 1:3535 CAHUENGA BLVD W STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1359
Mailing Address - Country:US
Mailing Address - Phone:323-968-3535
Mailing Address - Fax:323-435-5138
Practice Address - Street 1:3535 CAHUENGA BLVD W STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1359
Practice Address - Country:US
Practice Address - Phone:323-968-3535
Practice Address - Fax:323-435-5138
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZV01363Medicare UPIN