Provider Demographics
NPI:1881792554
Name:MALLORY, DALE R (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:MALLORY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4402 BROADWAY BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-8263
Mailing Address - Country:US
Mailing Address - Phone:972-240-7600
Mailing Address - Fax:972-240-1353
Practice Address - Street 1:4402 BROADWAY BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-8263
Practice Address - Country:US
Practice Address - Phone:972-240-7600
Practice Address - Fax:972-240-1353
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601092Medicare ID - Type Unspecified