MEDICARE: PHILLIP MALETTA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301010295	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2301010295	OTHER	MI	LICENSE

General Provider Information

NPI Number	:	1114318235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP MALETTA DC

Provider Business Mailing Address
First Line	:	500 W 17TH ST
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-3437
Country	:	US
Telephone Number	:	616-392-7031
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W 17TH ST
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-3437
Country	:	US
Telephone Number	:	616-392-7031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	05/26/2026

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Directions to “ PHILLIP MALETTA DC” Practice Location

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