Provider Demographics
NPI:1811256142
Name:MALO CHIROPRACTIC
Entity type:Organization
Organization Name:MALO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILLEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-759-3020
Mailing Address - Street 1:201 ROUTE 17 FL 11
Mailing Address - Street 2:11041
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2557
Mailing Address - Country:US
Mailing Address - Phone:973-759-3050
Mailing Address - Fax:973-759-2046
Practice Address - Street 1:201 ROUTE 17 FL 11
Practice Address - Street 2:11041
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2557
Practice Address - Country:US
Practice Address - Phone:973-759-3050
Practice Address - Fax:973-759-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty