Provider Demographics
NPI:1841296290
Name:MALWITZ, CHAD ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALAN
Last Name:MALWITZ
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 1:105 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-2407
Mailing Address - Country:US
Mailing Address - Phone:507-525-2931
Mailing Address - Fax:
Practice Address - Street 1:105 N GROVE ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-2407
Practice Address - Country:US
Practice Address - Phone:507-526-5656
Practice Address - Fax:507-526-5757
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN157L4WEOtherBCBS NUMBER
MN172131300Medicaid
MN157L4WEOtherBCBS NUMBER
MN64710Medicare UPIN