MEDICARE: VIVIAN K MALNIKOF 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	0104556374	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190001295	OTHER	VA	MEDICARE

General Provider Information

NPI Number	:	1508922998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN K MALNIKOF DC

Provider Business Mailing Address
First Line	:	46169 WESTLAKE DR
Second Line	:	STE 300
City	:	STERLING
State	:	VA
Zip	:	20165-5875
Country	:	US
Telephone Number	:	703-421-2990
Fax Number	:	703-421-2822

Provider Business Practice Location Address
First Line	:	46169 WESTLAKE DR
Second Line	:	SUITE 300
City	:	STERLING
State	:	VA
Zip	:	20165-5875
Country	:	US
Telephone Number	:	703-421-2990
Fax Number	:	703-421-2822

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	01/16/2015

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