Provider Demographics
NPI:1841476769
Name:MALLORY, DAVID A (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MALLORY
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 1:1033 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-6151
Mailing Address - Country:US
Mailing Address - Phone:386-248-8000
Mailing Address - Fax:386-252-1850
Practice Address - Street 1:1033 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-6151
Practice Address - Country:US
Practice Address - Phone:386-248-8000
Practice Address - Fax:386-252-1850
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU58920Medicare UPIN
FL55361Medicare PIN