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NPI Code Detail

MEDICARE: MALINA CHIROPRACTIC CLINIC LLC

MEDICARE: MALINA CHIROPRACTIC CLINIC LLC
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
1111N00000XChiropractor08535GA
2111N00000XChiropractor1234GA

General Provider Information

NPI Number : 1295170215
Entity Type Code : Organization
Provider Name (Legal Business Name) : MALINA CHIROPRACTIC CLINIC LLC
Provider Business Mailing Address
First Line : 3826 N DRUID HL RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-3015
Country : US
Telephone Number : 404-326-3609
Fax Number : 404-325-8859
Provider Business Practice Location Address
First Line : 3826 N DRUID HILLS RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-3015
Country : US
Telephone Number : 404-325-3609
Fax Number : 404-325-8859
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. CAMILLE JEAN MALINA
Credential :
Telephone Number : 404-325-3609
Provider Enumeration Date : 05/03/2013
Last Update Date : 05/03/2013

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Directions to “MALINA CHIROPRACTIC CLINIC LLC ” Practice Location

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