Healthcare Provider Details

I. General information

NPI: 1659837904
Provider Name (Legal Business Name): PAYTON M MALOCHLEB DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 W GENESEE ST STE 2
FRANKENMUTH MI
48734-1357
US

IV. Provider business mailing address

526 W GENESEE ST STE 4
FRANKENMUTH MI
48734-1357
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-2577
  • Fax: 989-652-4776
Mailing address:
  • Phone: 989-652-2577
  • Fax: 989-652-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number230101685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: