MEDICARE: DR. KATIE LYNN MALLEY D.C.

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	CH 10627	FL

General Provider Information

NPI Number	:	1730448077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATIE LYNN MALLEY D.C.

Provider Business Mailing Address
First Line	:	2480 CYPRESS POND RD
Second Line	:	APT 412
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1537
Country	:	US
Telephone Number	:	774-272-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 CYPRESS POND RD
Second Line	:	APT 412
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1537
Country	:	US
Telephone Number	:	774-272-1151
Fax Number	:

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

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	03/08/2016

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