MEDICARE: DR. DALE R MALLORY 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	2839	TX

General Provider Information

NPI Number	:	1881792554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE R MALLORY D.C.

Provider Business Mailing Address
First Line	:	4402 BROADWAY BLVD
Second Line	:	SUITE 9
City	:	GARLAND
State	:	TX
Zip	:	75043-8263
Country	:	US
Telephone Number	:	972-240-7600
Fax Number	:	972-240-1353

Provider Business Practice Location Address
First Line	:	4402 BROADWAY BLVD
Second Line	:	SUITE 9
City	:	GARLAND
State	:	TX
Zip	:	75043-8263
Country	:	US
Telephone Number	:	972-240-7600
Fax Number	:	972-240-1353

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/26/2010

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