Healthcare Provider Details

I. General information

NPI: 1053343202
Provider Name (Legal Business Name): MALON CHIROPRACTIC CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 ELM STREET
BIDDEFORD ME
04005-3032
US

IV. Provider business mailing address

322 ELM STREET
BIDDEFORD ME
04005-3032
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-0104
  • Fax: 207-283-4322
Mailing address:
  • Phone: 207-283-0104
  • Fax: 207-283-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC G MALON
Title or Position: OWNER
Credential: D.C.
Phone: 207-283-0104